Role of MRI in Detecting Cerebral Anomalies and Cerebral Hypoperfusion in Surviving Twin after the Co Twin Demise of Monochorionic Twin Pregnancy.

Aim: To demonstrate the role of MRI in detecting cerebral anomalies and cerebral hypo perfusion in surviving twin after the co twin demise of monochorionic twin pregnancy. Case Presentation: 28 year old second gravida came for routine antenatal sonography at 29 weeks. Her routine anomaly scan at 20 weeks for her twin gestation was unremarkable. Present antenatal sonography revealed monochorionic diamniotic twin pregnancy with demise of one of the twins at 23 weeks. Ultrasound and doppler evaluation did not exhibit abnormality in surviving twin whereas MR evaluation revealed changes in feral brain due to ischaemia. Discussion: Mono chorionic twin pregnancies are associated with numerous complications due to vascular anastomotic channels in the shared placenta. Complications include Twin to Twin Transfusion Syndrome, Anaemia - polycythemia sequence, selective intra uterine growth retardation, cotwin demise, neurological damage in surviving twin. Though prenatal Doppler sonography is often used for neurological assessment of the surviving twin, in utero Magnetic Resonance Imaging of foetal brain aids in definitive diagnosis of cerebral pathologies. Conclusion: MRI plays an important role in assessing cerebral hypo perfusion injuries and cerebral anomalies.

Fetal central nervous system magnetic resonance imaging at the University Hospital of the West Indies, Jamaica / Imagen por resonancia magnética del sistema nervioso central fetalen el Hospital Universitario de West Indies, Jamaica

BACKGROUND: Compared with ultrasound, magnetic resonance imaging (MRI) offers superior visualization of the fetal brain. It confirms and characterizes brain abnormalities detected by prenatal ultrasound, particularly in late pregnancy when acoustic windows are difficult or fetal position is inaccessible. Prior to July 2008, only two studies were attempted at our institution as local technical expertise was unavailable. Following collaboration with a neuroradiologist at an expert centre, images of sufficient quality for diagnosis were obtained. OBJECTIVE: The study objective is to evaluate the initial experience with fetal brain MRI and its effects on patient counselling and management in a resource limited healthcare system. METHOD: In seven fetuses with abnormal ultrasound neuroimaging, fetal MRI was performed with T2- weighted single-shot fast spin-echo (SSFSE) sequences using a 1.5T magnet (GE Medical Systems, Milwaukee, WI). RESULTS: Magnetic resonance imaging did not alter ultrasound diagnosis in two patients (28%); however, it changed the diagnosis in three (43%), provided additional information in one (14%) and changed management in two (28%) patients. CONCLUSION: Magnetic resonance imaging availability further elucidated brain pathology, aided patient counselling, parental decision-making and multidisciplinary management.

ANTECEDENTES: A diferencia del ultrasonido, la imagen por resonancia magnética (IRM) ofrece una visualización superior del cerebro fetal. Mediante ella, se hace posible confirmar y caracterizar las anormalidades detectadas por el ultrasonido prenatal, particularmente en la última etapa del embarazo, cuando las ventanas acústicas son difíciles, o la posición fetal es inaccesible. Antes del 2008 de julio, se intentaron sólo dos estudios en nuestra institución, ya que a nivel local no se disponía de conocimientos técnicos especializados. Tras la colaboración con un neuroradiólogo en un centro especializado, se obtuvieron imágenes de calidad suficiente para realizar el diagnóstico. OBJETIVO: El objetivo del estudio es evaluar la experiencia inicial con el IRM del cerebro fetal y sus efectos en cuanto a brindar consejos y tratamiento a los pacientes en un sistema de atención a la salud con recursos limitados. MÉTODO: En siete fetos con neuroimágenes de ultrasonido anormales, se llevó a cabo un IRM fetal con secuencias potenciadas en T2 como single-shot fast spin-echo (SSFSE), usando un imán 1.5T (GE Medical Systems, Milwaukee, WI). RESULTADOS: La imagen por resonancia magnética (IRM) no alteró el diagnóstico del ultrasonido en dos pacientes (28%). Sin embargo, cambió el diagnóstico en tres (43%), dio información adicional en uno (14%), y cambió el tratamiento en dos (28%) pacientes. CONCLUSIÓN: Poder contar con la imagen de resonancia magnética permitió dilucidar aún más la patología del cerebro, ayudar a dar consejos al paciente, tomar decisiones a los padres, y alcanzar un tratamiento multidisciplinario.

Prenatal MRI Findings of Fetuses with Congenital High Airway Obstruction Sequence

OBJECTIVE: To define the MRI findings of congenital high airway obstruction sequence (CHAOS) in a series of fetuses. MATERIALS AND METHODS: Prenatal fetal MR images were reviewed in seven fetuses with CHAOS at 21 to 27 weeks of gestation. The MRI findings were reviewed. The MRI parameters evaluated included the appearance of the lungs and diaphragm, presence or absence of hydrops, amount of amniotic fluid, airway appearance, predicted level of airway obstruction, and any additional findings or suspected genetic syndromes. RESULTS: All the fetuses viewed (7 of 7) demonstrated the following MRI findings: dilated airway below the level of obstruction, increased lung signal, markedly increased lung volumes with flattened or inverted hemidiaphragms, massive ascites, centrally positioned and compressed heart, as well as placentomegaly. Other frequent findings were anasarca (6 of 7) and polyhydramnios (3 of 7). MRI identified the level of obstruction as laryngeal in five cases and tracheal in two cases. In four of the patients, surgery or autopsy confirmed the MRI predicted level of obstruction. Associated abnormalities were found in 4 of 7 (genetic syndromes in 2). Postnatal radiography (n = 3) showed markedly hyperinflated lungs with inverted or flattened hemidiaphragms, strandy perihilar opacities, pneumothoraces and tracheotomy. Two fetuses were terminated and one fetus demised in utero. Four fetuses were delivered via ex utero intrapartum treatment procedure. CONCLUSION: MRI shows a consistent pattern of abnormalities in fetuses with CHAOS, accurately identifies the level of airway obstruction, and helps differentiate from other lung abnormalities such as bilateral congenital pulmonary airway malformation by demonstrating an abnormally dilated airway distal to the obstruction.

The Usefulness of Fetal MRI for Prenatal Diagnosis

PURPOSE: Fast MRI has provided detailed and reproducible fetal anatomy. This study was performed to evaluate the usefulness of fetal MRI for prenatal diagnosis. MATERIALS AND METHODS: Fifty-six fetuses with congenital abnormalities on ultrasonography were evaluated by fetal MRI from 2001 to 2004 in Severance Hospital. Final diagnosis was made by postnatal pathology, postnatal MRI, and other modalities (such as ultrasound, retrograde pyelogram). A 1.5-Tesla superconductive MR imaging unit was used to obtain half-Fourier acquisition single-shot turbo spin images. RESULTS: Of the 56 fetuses, intracranial abnormalities were found in 26 fetuses, intraabdominal abnormalities in 17 fetuses, intrathoracic in 6 fetuses, head and neck in 5 fetuses, and other sites in 2 fetuses. There were six cases in which the diagnoses of fetal MRI and ultrasonography differed. In such cases, fetal MRI provided more exact diagnosis than ultrasonography (5 vs. 0). Three fetuses with intracranial abnormalities on ultrasonography were diagnosed as normal by fetal MRI and in postnatal diagnosis. CONCLUSION: Although ultrasonography is known as a screening modality of choice in the evaluation of fetus because of the cost-effectiveness and safety, the sonographic findings are occasionally inconclusive or insufficient for choosing the proper management. Thus, in this study, we suggest that fetal MRI is more useful than ultrasonography for the evaluation of intracranial abnormalities in some instances. For prenatal counseling and postnatal treatment planning, fetal MRI can be informative when prenatal ultrasonography is inadequate and doubtful.

Agenesis of corpus callosum prenatally diagnosed with fetal MRI: case report / 대한산부인과학회지

Agenesis of corpus callosum is the cerebral malformations whose prognosis is uncertain. But the complete agenesis shows more poor prognosis than partial agenesis. So, the type of agenesis can affect significantly the antepartum management. Recently, there has been a development in diagnostic tools like MRI to overcome these limitations of antenatal ultrasonography. We report a case of agenesis of corpus callosum which was diagnosed by prenatal MRI. This case was confused with Dandy-Walker complex in prenatal ultrasonography and supported in diagnosis by prental MRI.

A Case of Prenatally Diagnosed Fetal Retroperitoneal Cystic Lymphangioma / 대한산부인과학회잡지

Lymphangiomas are congenital malformations of lymphatic vessels that have the potential to infiltrate surrounding structures. In 95% of cases, they are located in the neck (cystic hygroma), head and axilla. But they can occur in a variety of anatomical locations, such as the abdominal cavity, extremities and urinary bladder. Pathologically they can be classified into three group: lymphangioma simplex; carvenous lymphangioma; and cystic lymphangiomas or hygromas. Mixed lesions may coexist in different areas of the same lymphangioma. Although these lesions are benign, they have a propensity for rapid growth and invasion into the underlying muscles and connective tissues. A extensive mass can compress adjacent vital organs, which determines the severity of the lesion. Accurate prenatal diagnosis and anatomical evaluation are important as they permit planned delivery and prompt postnatal resuscitation, and allow the option of terminating the pregnancy if a poor outcome is predicted. Prenatal MRI can confirm ultrasonographic findings, provide detailed fetal anatomical evaluation, and demonstrate the extent and character of lymphangiomas. We present a case of a huge retroperitoneal cystic lymphangioma diagnosed prenatally using ultrasound and MRI at 26 weeks gestation.