ABSTRACT
INTRODUCTION: We hypothesized that magnetic resonance imaging (MRI) can assess fetuses with sonographically (ultrasonography (US))-suspected neural tube defects (NTD) that might influence their diagnoses and management decision. METHODS: Institutional review board approval and informed consents were obtained to perform MRI for 19 fetuses referred with US-suspected NTD. Prenatal imaging findings were correlated with management decision, postnatal clinical, postnatal imaging, and pathology. RESULTS: Prenatal MRI correctly ruled out US diagnosis of cephalocele in a fetus. In the other 18 fetuses, MRI detected detailed topography and contents of NTD sacs in five, added central nervous system (CNS) abnormalities that were not apparent on US in three, and confirmed non-CNS findings in three fetuses. MRI changed diagnosis of 3/19 fetuses (15.8%), caused minor change in diagnosis of 5/19 (26.3%), and did not influence US diagnosis of 11/19 fetuses (57.9%). MRI findings changed/modified management decision in 21% of the fetuses. CONCLUSION: Fetal MRI is an important adjunct to US in assessing NTD. It can identify topography and contents of sacs, add CNS and non-CNS findings, and influence management decision.
Subject(s)
Fetus/pathology , Magnetic Resonance Imaging/methods , Neural Tube Defects/diagnosis , Neural Tube Defects/pathology , Prenatal Diagnosis/methods , Anencephaly/diagnosis , Anencephaly/diagnostic imaging , Anencephaly/pathology , Cysts/diagnosis , Cysts/pathology , Cysts/ultrastructure , Diagnosis, Differential , Humans , Meningocele/diagnosis , Meningocele/diagnostic imaging , Meningocele/pathology , Meningomyelocele/diagnosis , Meningomyelocele/diagnostic imaging , Meningomyelocele/pathology , Neural Tube Defects/diagnostic imaging , Ultrasonography, PrenatalABSTRACT
The hypothalamus is susceptible to involvement by a variety of processes, including developmental abnormalities, primary tumors of the central nervous system (CNS), vascular tumors, systemic tumors affecting the CNS, and inflammatory and granulomatous diseases. The hypothalamus may also be involved by lesions arising from surrounding structures such as the pituitary gland. Magnetic resonance (MR) imaging is the modality of choice for evaluating the anatomy and pathologic conditions of the hypothalamus. The MR imaging differential diagnosis depends on accurate anatomic localization and tissue characterization of hypothalamic lesions through the recognition of their signal intensity and contrast material enhancement patterns. Diffusion-weighted imaging and proton MR spectroscopy can be helpful in differentiating among various types of hypothalamic lesions. Key MR imaging features, in addition to the patient's age and clinical findings at presentation, may be helpful in developing the differential diagnosis for lesions involving the hypothalamic region.
