Neonatal and Infant Lung Disorders: Glossary, Practical Approach, and Diagnoses.

A multitude of lung disorders ranging from congenital and genetic anomalies to iatrogenic complications can affect the neonate or the infant within the first year of life. Neonatal and infant chest imaging, predominantly by plain radiography and computed tomography, is frequently employed to aid in diagnosis and management; however, these disorders can be challenging to differentiate due to their broad-ranging, and frequently overlapping radiographic features. A systematic and practical approach to imaging interpretation which includes recognition of radiologic patterns, utilization of commonly accepted nomenclature and classification, as well as interpretation of imaging findings in conjunction with clinical history can not only assist radiologists to suggest the diagnosis, but also aid clinicians in management planning. The contents of this article were endorsed by the leadership of both the World Federation of Pediatric Imaging (WFPI), and the International Society of Pediatric Thoracic Imaging (ISPTI).

Unusual pediatric lung infections: imaging findings.

Pediatric lung infections continue to be a leading cause of pediatric morbidity and mortality. Although both pediatric and general radiologists are familiar with typical lung infections and their imaging findings in children, relatively rare lung infections continue to present a diagnostic challenge. In addition, the advances in radiological imaging and emergence of several new lung infections in recent years facilitated the need for up-to-date knowledge on this topic. In this review article, we discuss the imaging findings of pediatric lung infections caused by unusual/uncommon and new pathogens. We review the epidemiological, clinical, and radiological imaging findings of viral (coronavirus disease 2019, Middle East respiratory syndrome, bird flu), bacterial (Streptococcus anginosus, Francisella tularensis, Chlamydia psittaci), and parasitic lung infections (echinococcosis, paragonimiasis, amoebiasis). Additional disorders whose clinical course and imaging findings may mimic lung infections in children (hypersensitivity pneumonitis, pulmonary hemorrhage, eosinophilic pneumonia) are also presented, to aid in differential diagnosis. As the clinical presentation of children with new and unusual lung infections is often non-specific, imaging evaluation plays an important role in initial detection, follow-up for disease progression, and assessment of potential complications.

Pulmonary imaging in coronavirus disease 2019 (COVID-19): a series of 140 Latin American children.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which resulted in the worldwide coronavirus disease 2019 (COVID-19) pandemic of 2020, has particularly affected Latin America. OBJECTIVE: The purpose of the study was to analyze the imaging findings of pulmonary COVID-19 in a large pediatric series. MATERIALS AND METHODS: Children with SARS-CoV-2 infection confirmed by either quantitative reverse transcription-polymerase chain reaction from nasopharyngeal swabs or presence of circulating immunoglobulin M (IgM) antibodies and who underwent chest radiograph or CT or both were included in this retrospective multicenter study. Three pediatric radiologists independently reviewed radiographs and CTs to identify the presence, localization, distribution and extension of pulmonary lesions. RESULTS: We included 140 children (71 female; median age 6.3 years, interquartile range 1.6-12.1 years) in the study. Peribronchial thickening (93%), ground-glass opacities (79%) and vascular engorgement (63%) were the most frequent findings on 131 radiographs. Ground-glass opacities (91%), vascular engorgement (84%) and peribronchial thickening (72%) were the most frequent findings on 32 CTs. Peribronchial thickening (100%), ground-glass opacities (83%) and pulmonary vascular engorgement (79%) were common radiograph findings in asymptomatic children (n=25). Ground-glass opacity and consolidation were significantly higher in children who needed intensive care admission or died (92% and 48%), in contrast with children with a favorable outcome (71% and 24%, respectively; P<0.05). CONCLUSION: Asymptomatic children and those with mild symptoms of COVID-19 showed mainly peribronchial thickening, ground-glass opacities and pulmonary vascular engorgement on radiographs. Ground-glass opacity and consolidation were more common in children who required intensive care admission or died.

Tomographic findings in bronchial atresia.

OBJECTIVE: To evaluate computed tomography (CT) findings in 23 patients with bronchial atresia. MATERIALS AND METHODS: The CT images were reviewed by two radiologists who reached decisions by consensus. We included only patients who presented with abnormalities on CT and in whom the diagnosis had been confirmed by pathological examination of the surgical specimen (if the lesion was resected). The CT scans were assessed in order to identify the main findings and to map the distribution of the lesions (i.e., to determine whether the pulmonary involvement was unilateral or bilateral). RESULTS: The main CT finding was the combination of bronchocele and hyperinflation of the distal lung. That combination was observed in all of the patients. The lesions were unilateral in all 23 cases, being seen predominantly in the left upper lobe, followed by the right lower lobe, right upper lobe, middle lobe, and left lower lobe. CONCLUSION: The diagnosis of bronchial atresia can be reliably made on the basis of a finding of bronchocele accompanied by hyperinflation of the adjacent lung parenchyma.

OBJETIVO: Analisar os achados na tomografia computadorizada (TC) de tórax de 23 pacientes com atresia brônquica. MATERIAIS E MÉTODOS: As imagens de TC foram avaliadas por dois observadores e os casos discordantes foram resolvidos por consenso. Os critérios de inclusão foram a presença de anormalidades na TC compatíveis com atresia brônquica e/ou diagnóstico confirmado por exame anatomopatológico das peças cirúrgicas para os pacientes submetidos a ressecção cirúrgica. As TCs foram avaliadas quanto aos principais achados de imagem, à distribuição das lesões, ao envolvimento pulmonar unilateral ou bilateral. RESULTADOS: Os principais achados na TC foram a presença de broncocele, hiperinsuflação do parênquima pulmonar ou ambos. A combinação desses achados foi encontrada em todos os pacientes. Em relação à distribuição, o envolvimento foi unilateral nos 23 casos. Quando se consideraram os lobos mais acometidos, o lobo superior esquerdo foi o mais acometido, seguido do lobo inferior direito, lobo superior direito, lobo médio e lobo inferior esquerdo. CONCLUSÃO: O diagnóstico de atresia brônquica pode ser feito em presença de broncocele associada com hiperinsuflação do parênquima pulmonar adjacente.

Tomographic findings in bronchial atresia / Achados tomográficos na atresia brônquica

Abstract Objective: To evaluate computed tomography (CT) findings in 23 patients with bronchial atresia. Materials and Methods: The CT images were reviewed by two radiologists who reached decisions by consensus. We included only patients who presented with abnormalities on CT and in whom the diagnosis had been confirmed by pathological examination of the surgical specimen (if the lesion was resected). The CT scans were assessed in order to identify the main findings and to map the distribution of the lesions (i.e., to determine whether the pulmonary involvement was unilateral or bilateral). Results: The main CT finding was the combination of bronchocele and hyperinflation of the distal lung. That combination was observed in all of the patients. The lesions were unilateral in all 23 cases, being seen predominantly in the left upper lobe, followed by the right lower lobe, right upper lobe, middle lobe, and left lower lobe. Conclusion: The diagnosis of bronchial atresia can be reliably made on the basis of a finding of bronchocele accompanied by hyperinflation of the adjacent lung parenchyma.

Resumo Objetivo: Analisar os achados na tomografia computadorizada (TC) de tórax de 23 pacientes com atresia brônquica. Materiais e Métodos: As imagens de TC foram avaliadas por dois observadores e os casos discordantes foram resolvidos por consenso. Os critérios de inclusão foram a presença de anormalidades na TC compatíveis com atresia brônquica e/ou diagnóstico confirmado por exame anatomopatológico das peças cirúrgicas para os pacientes submetidos a ressecção cirúrgica. As TCs foram avaliadas quanto aos principais achados de imagem, à distribuição das lesões, ao envolvimento pulmonar unilateral ou bilateral. Resultados: Os principais achados na TC foram a presença de broncocele, hiperinsuflação do parênquima pulmonar ou ambos. A combinação desses achados foi encontrada em todos os pacientes. Em relação à distribuição, o envolvimento foi unilateral nos 23 casos. Quando se consideraram os lobos mais acometidos, o lobo superior esquerdo foi o mais acometido, seguido do lobo inferior direito, lobo superior direito, lobo médio e lobo inferior esquerdo. Conclusão: O diagnóstico de atresia brônquica pode ser feito em presença de broncocele associada com hiperinsuflação do parênquima pulmonar adjacente.

Symmetric and ventrally conjoined twins: prenatal evaluation by ultrasound and magnetic resonance imaging and postnatal outcomes.

OBJECTIVE: To review the perinatal and long-term outcomes of symmetric and ventrally conjoined twins evaluated prenatally by ultrasound and fetal magnetic resonance imaging (MRI). METHODS: From March 2010 to January 2019, cases of symmetric and ventrally conjoined twins, who were prenatally diagnosed and referred to the Clínica Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil, for prenatal evaluation by ultrasound and MRI were selected. The postnatal information was collected from hospitals where the twins were born and/or treated and from parents' verbal and written information. RESULTS: Four cases of symmetrical and ventrally conjoined twins were selected. Of these, two were omphalopagi and two thoracopagi. One pair of thoracomphalopagus died early in utero and the other died 6 days after birth. The outcome of the two omphalopagus pairs were separation in emergency surgeries after birth, with neonatal demise of one of the twins due to congenital malformations. In cases of omphalopagi, fetal MRI presented important information of the twins' anatomy before emergency separation of both pairs. CONCLUSION: Despite the apparently similar conditions of twins with ventral fusion, ventrally attached twins have very different outcomes, most adverse for thoracomphalopagus and related to the singular anatomy of the pair, associated malformations and the extension of the adhesion, requiring individual evaluation of the cases. Fetal MRI is as an important tool for the postnatal surgery management of twin neonates, providing crucial information in cases where urgent separation is required.

International Expert Consensus Statement on Chest Imaging in Pediatric COVID-19 Patient Management: Imaging Findings, Imaging Study Reporting, and Imaging Study Recommendations.

Coronavirus disease 2019 (COVID-19) has quickly spread since it was first detected in December 2019 and has evolved into a global pandemic with over 1.7 million confirmed cases in over 200 countries around the world at the time this document is being prepared. Owing to the novel nature of the virus and the rapidly evolving understanding of the disease, there is a great deal of uncertainty surrounding the diagnosis and management of COVID-19 pneumonia in pediatric patients. Chest imaging plays an important role in the evaluation of pediatric patients with COVID-19; however, there is currently little information available describing imaging manifestations of COVID-19 in pediatric patients and even less information discussing the utilization of imaging studies in pediatric patients. To specifically address these concerns, a group of international experts in pediatric thoracic imaging from five continents convened to create a consensus statement describing the imaging manifestations of COVID-19 in the pediatric population, discussing the potential utility of structured reporting during the COVID-19 pandemic, and generating consensus recommendations for utilization of chest radiographs and CT in the evaluation of pediatric patients with COVID-19. The results were compiled into two structured reporting algorithms (one for chest radiographs and one for chest CT) and eight consensus recommendations for the utilization of chest imaging in pediatric COVID-19 infection. © RSNA, 2020.

Perceived Impact of COVID-19 on Pediatric Radiology Departments Around the World: WFPI COVID-19 Task Force Survey Results from 6 Continents.

PURPOSE: To investigate how COVID-19 has impacted pediatric radiology practice around the world at the present time. MATERIALS AND METHODS: This study was based on a survey conducted by the World Federation of Pediatric Imaging (WFPI) COVID-19 task force. Pediatric radiology representatives from countries around the world were identified and asked to complete an electronic survey consisting of 17 questions related to the impact of, concerns surrounding, and education related to COVID-19 on pediatric radiology. For each outcome variable, a pair of 2-way frequency tables was constructed: one against COVID-19 prevalence, and another against region. Tests of independence of the tables' row and column factors were performed based on Fisher's exact test and odds ratios (OR) were estimated via logistic regression models corresponding to these 2-way tables. RESULTS: The survey (response rate 87%, 72/83) comprised representatives from 71 countries and Hong Kong across 6 continents. 66/72 respondents (92%) indicated that COVID-19 has resulted in moderate (21/72, 29%), significant (36/72, 50%), or complete (9/72, 13%) change in radiology departments/practices in their countries. The two most frequent concerns over the next four months were personal/family health (54/72, 75%) and exposure (48/72, 67%). 79% (57/72) of respondents indicated some level of discomfort in identifying pediatric COVID-19 imaging manifestations. Changes in resident education were reported by 68/72 (94%) respondents, and 22/72 (31%) were concerned that the likelihood of current trainees pursuing a career in pediatric radiology will be impacted. CONCLUSION: COVID-19 has had a substantial negative impact on pediatric radiology practice around the world.

Prenatal diagnosis of cervical masses by magnetic resonance imaging and 3D virtual models: perinatal and long-term follow-up outcomes.

Objective: To assess perinatal and long-term follow-up outcomes of fetal cervical masses diagnosed by three-dimensional (3D) magnetic resonance imaging (MRI) and 3D virtual models.Methods: This retrospective cohort study evaluated 15 pregnant women (age, 21-38 years) at 29-40 weeks of singleton gestation, whose fetuses exhibited congenital oral and cervical masses. These women were referred to our facility because of suspected fetal malformations on routine obstetric ultrasound, and the cases were confirmed, excluded, or complemented by MRI. Demographic data and perinatal and long-term follow-up outcomes were assessed.Results: Cervical masses were predominant in females (3:2), and the most frequent diagnosis was lymphatic-venous malformation (71%). The masses were cystic in 53.3% of the cases and solid in 46.7%. The esophagus and trachea were displaced in 46.6% of the cases. Associated malformations were diagnosed in 13.3% of the cases. There was complete agreement between prenatal MRI and postnatal diagnoses. Among the newborns, 40% had complications and 46.6% were admitted to the neonatal intensive care unit. Two infants died from complications due to epignathus. Surgical resection was performed in 33.3% of the cases, including complete resection in 26.6%. Sclerotherapy was administered to 53.3% of the cases, with complete remission achieved in 50% of these cases.Conclusion: Cervical masses diagnosed in the prenatal period had good postnatal outcomes except for cases of epignathus, which were associated with high mortality. MRI demonstrated the relationship between cervical masses and adjacent organs and allowed 3D virtual reconstruction of the airways. There was complete agreement between the prenatal diagnosis of cervical masses on MRI and postnatal diagnosis. Surgical treatment was effective in most cases, and sclerotherapy was satisfactory in cases with intrathoracic components.

Association Between Neonatal Neuroimaging and Clinical Outcomes in Zika-Exposed Infants From Rio de Janeiro, Brazil.

Importance: Congenital Zika virus (ZIKV) infection may present with a spectrum of clinical and neuroradiographic findings. Objective: To determine whether neuroimaging findings for infants with a history of ZIKV exposure are associated with infant clinical outcomes and gestational age at antenatal ZIKV infection. Design, Setting, and Participants: This cohort study retrospectively reviewed neuroimaging results (computed tomography and/or magnetic resonance imaging scans) of 110 ZIKV-exposed infants from a maternity and children's hospital in Rio de Janeiro, Brazil, following the 2015 to 2016 ZIKV epidemic. Neuroimaging from March 1, 2016, to June 30, 2017, was evaluated to determine whether findings were associated with clinical outcomes and the timing of maternal ZIKV infection. Data were analyzed from July 1, 2017, to August 30, 2018. Exposures: Neuroimaging (computed tomography and/or magnetic resonance imaging) was performed on ZIKV-exposed infants after birth. Blood and/or urine specimens from mothers and infants were tested for ZIKV by polymerase chain reaction assay. Main Outcomes and Measures: Neuroimaging studies were evaluated for structural abnormalities and other forms of brain injury. Results: A total of 110 infants with a mean (SD) gestational age of 38.4 (2.1) weeks had neuroimaging and clinical outcome data reviewed. Of these, 71 (65%) had abnormal neuroimaging findings, with the majority (96%) classified as having severe ZIKV infection at birth. The most common neuroimaging abnormalities were structural abnormalities including brain calcifications, especially at the cortico-subcortical white matter junction, cortex malformations, ventriculomegaly, and reduced brain volumes, followed by brainstem hypoplasia, cerebellar hypoplasia, and corpus callosum abnormalities. Frequency of abnormal imaging was higher in infants with specific clinical findings as opposed to those without them; these findings included fetal brain disruption sequence (100% vs 35%), microcephaly (100% vs 30%), congenital contractures (100% vs 58%), ophthalmologic abnormalities (95% vs 44%), hearing abnormalities (100% vs 58%), and neurologic symptoms (94% vs 10%). Four of 39 infants (10%) without initial evidence of severe ZIKV infection and normal findings on neurologic evaluation at birth had abnormal neuroimaging findings. Neuroimaging abnormalities differed by trimester of maternal ZIKV infection, with 63% of infants born to mothers infected in the first trimester, 13% of infants born to mothers infected in the second trimester, and 1% of infants born to mothers infected in the third trimester exhibiting neuroimaging abnormalities. The odds of abnormal neuroimaging were 7.9 times greater for infants with first trimester ZIKV exposure compared with other trimesters combined (odds ratio, 7.9; 95% CI, 3.0-20.4; P < .001). Conclusions and Relevance: Neuroimaging abnormalities of computed tomography and/or magnetic resonance imaging scans were common in ZIKV-exposed infants. While neuroimaging abnormalities were seen in 10% of infants without clinically severe ZIKV, most occurred almost exclusively among those with clinically severe ZIKV, especially among those with a history of ZIKV exposure in the first trimester.

Back to Fundamentals: Radiographic Evaluation of Thoracic Lines and Tubes in Children.

OBJECTIVE. The purpose of this article is to provide an up-to-date review of the radiographic appearance of the most commonly used thoracic lines and tubes in pediatric patients in daily clinical practice. CONCLUSION. Thoracic support lines and tubes are frequently used in children receiving hospital care. Evaluation of these devices is a fundamental skill in radiology. Many different devices are currently used, and new devices are regularly introduced. It is essential for radiologists to maintain a clear understanding of all devices currently in use.

Applicability of Magnetic Resonance Imaging in the Assessment of Fetal Urinary Tract Malformations.

OBJECTIVE: To assess the applicability of magnetic resonance imaging (MRI) to complement ultrasound in the diagnosis of fetal urinary tract anomalies. METHODS: This was a retrospective cohort study that included 41 women between 19 weeks and 37 weeks and 6 days of gestation carrying fetuses with malformations of the urinary tract which were initially diagnosed by ultrasound and then referred for MRI. In all cases, the diagnosis was confirmed after birth either through imaging or autopsy. A surface coil was positioned over the abdomen and T2-weighted sequences were obtained in the axial, coronal, and sagittal planes; T1 in at least one plane; and three-dimensional (3-D) TRUFI in fetuses with dilatation of the urinary tract. RESULTS: Mean gestational age at the time of MRI examination was 28.21 weeks. The rapid T2 sequences allowed all the anomalies of the fetal urinary tract to be assessed, whereas 3-D TRUFI sequencing proved very useful in evaluating anomalies involving dilatation of the urinary tract. The signs of pulmonary hypoplasia characterized by hypointense signal in the T2-weighted sequences were identified in 13 of the 41 fetuses. CONCLUSION: MRI confirmed and added information to the ultrasound regarding fetal urinary tract anomalies, as well as information related to the other associated malformations, their progress in the prenatal period, and possible postnatal prognosis.

Prenatal diagnosis of suprarenal mass by magnetic resonance imaging: a case series.

Objective: The aim of this study was to evaluate the perinatal outcomes and postnatal follow-up of prenatally diagnosed suprarenal masses (SRMs) evaluated by magnetic resonance imaging (MRI). Methods: Thirteen fetuses with SRMs detected during routine prenatal ultrasound screening were evaluated by MRI between February 2007 and May 2015. The prenatal characteristics of the masses, complications of the pregnancies, and related malformations were collected as the postnatal clinical, radiological, and pathological data. Results: The median gestational age at MRI was 30 weeks (18-41), and birth weight was 3285 (1700-3750) g. The mean follow-up period was 6 years (1.3-10). We observed 69.2% of the masses, which were predominantly cystic (69.2%), located on the left side. Associated malformations were found in 23% of the fetuses, with congenital heart defects being more prevalent. During the pregnancy, 15.4% of the fetuses had involution of the SRM, and one fetus had surgical treatment and different ultrasound and MRI diagnoses. Of the 69.2% of the cases, spontaneous resolution occurred in 30.7% during the first year of life and 38.4% the masses presented without modifications or signs of regression since the neonatal period. Conclusions: Prenatal SRMs were associated with congenital heart defects. Spontaneous regression and absence of modifications in the masses were commonly observed in the long-term follow-up of the SRMs.

Three-dimensional reconstruction of fetal abnormalities using ultrasonography and magnetic resonance imaging.

Objective: We aimed to compare three-dimensional (3D) fetal malformation images obtained using ultrasonography (US) and magnetic resonance imaging (MRI) on the same day during the third trimester of pregnancy. Methods: Total 33 fetuses were selected from cases evaluated for malformations. Morphological abnormalities were first scanned using 3DUS. MRI was used to confirm the previous preliminary 3DUS findings, and diagnoses were confirmed postnatally. 3DUS scans were performed transabdominally using an Rab (4-8 L) probe, Voluson 730 Pro/Expert and E8 (General Electric, Healthcare, Zipf, Austria). MRI was performed using a 1.5-T scanner (Magneton Avanto, Siemens, Erlangen, Germany) with a body coil. The 3D reconstruction of the structure of interest was manually performed from a True FISP sequence using an interactive pen tablet (Syngo multimodality 2009B, Siemens, Erlangen, Germany). Results: Despite recent advancements in 3DUS, the quality of 3D images obtained from MRI was superior during the third trimester. 3DUS had certain limitations, such as being influenced by the fetal position, the volume of amniotic fluid, and maternal obesity. Fetal movements during image acquisition were one of the main challenges for MRI. Conclusion: The quality of the 3D images obtained using MRI was superior to that of images obtained using US during the third trimester of pregnancy.

The role of a novel magnetic resonance imaging sequence in the evaluation of the fetal skeleton: a pilot study.

OBJECTIVE: We aimed to study the role of magnetic resonance imaging (MRI), including a novel MRI sequence-the modified volumetric interpolated breath-hold examination (VIBE)-in the characterization of the fetal skeleton. This novel sequence was useful for reconstructing three-dimensional images of the skeleton. MATERIALS AND METHODS: We enrolled 22 pregnant women whose fetuses had shown congenital abnormalities on ultrasound examinations. The women underwent prenatal fetal MRI in a 1.5-T scanner with a T2-weighted modified VIBE sequence. Three-dimensional reconstructions of the fetal skeleton were performed manually on the instrument itself or via an interactive pen-tablet workstation. RESULTS: Three-dimensional reconstructions of the fetal skeleton were performed after the acquisition of modified VIBE MRI sequences, and it was possible to characterize the fetal skeleton in all MRI examinations. CONCLUSION: A detailed evaluation of the three-dimensional reconstructions of fetal skeleton performed after acquisition of a modified VIBE MRI sequence allowed a full characterization of the skeleton. However, improvements to the proposed sequence should be addressed in future studies.

OBJETIVO: O objetivo deste estudo foi demonstrar o papel da ressonância magnética (RM) incluindo uma nova sequência chamada de volumetric interpolated breath-hold examination (VIBE)) modificada que permita a reconstrução tridimensional para avaliação do esqueleto fetal. MATERIAIS E MÉTODOS: Foram analisadas 22 mulheres grávidas portando fetos com anomalias congênitas, não exclusivamente esqueléticas, as quais foram observadas em exame de ultrassonografia prévia. Para a aquisição das imagens de RM utilizou-se aparelho 1,5 T com a sequência VIBE modificada, ponderada em T2. Reconstruções tridimensionais foram feitas, manualmente, no próprio aparelho ou em uma estação de trabalho pen tablet interativo. RESULTADOS: Foi possível demonstrar a reconstrução tridimensional do esqueleto fetal por RM, com base em uma aquisição volumétrica da sequência VIBE modificada em todos os exames de RM do esqueleto fetal. CONCLUSÃO: Uma avaliação detalhada do esqueleto fetal pelas reconstruções tridimensionais realizadas após a aquisição da imagem usando sequência de RM VIBE modificada permitiu uma avaliação completa do esqueleto fetal, entretanto, as melhorias nessas sequências devem ser o foco de estudos futuros.

The role of a novel magnetic resonance imaging sequence in the evaluation of the fetal skeleton: a pilot study / O papel de uma nova sequência de ressonância magnética na avaliação do esqueleto fetal: um estudo piloto

Abstract Objective: We aimed to study the role of magnetic resonance imaging (MRI), including a novel MRI sequence-the modified volumetric interpolated breath-hold examination (VIBE)-in the characterization of the fetal skeleton. This novel sequence was useful for reconstructing three-dimensional images of the skeleton. Materials and Methods: We enrolled 22 pregnant women whose fetuses had shown congenital abnormalities on ultrasound examinations. The women underwent prenatal fetal MRI in a 1.5-T scanner with a T2-weighted modified VIBE sequence. Three-dimensional reconstructions of the fetal skeleton were performed manually on the instrument itself or via an interactive pen-tablet workstation. Results: Three-dimensional reconstructions of the fetal skeleton were performed after the acquisition of modified VIBE MRI sequences, and it was possible to characterize the fetal skeleton in all MRI examinations. Conclusion: A detailed evaluation of the three-dimensional reconstructions of fetal skeleton performed after acquisition of a modified VIBE MRI sequence allowed a full characterization of the skeleton. However, improvements to the proposed sequence should be addressed in future studies.

Resumo Objetivo: O objetivo deste estudo foi demonstrar o papel da ressonância magnética (RM) incluindo uma nova sequência chamada de volumetric interpolated breath-hold examination (VIBE)) modificada que permita a reconstrução tridimensional para avaliação do esqueleto fetal. Materiais e Métodos: Foram analisadas 22 mulheres grávidas portando fetos com anomalias congênitas, não exclusivamente esqueléticas, as quais foram observadas em exame de ultrassonografia prévia. Para a aquisição das imagens de RM utilizou-se aparelho 1,5 T com a sequência VIBE modificada, ponderada em T2. Reconstruções tridimensionais foram feitas, manualmente, no próprio aparelho ou em uma estação de trabalho pen tablet interativo. Resultados: Foi possível demonstrar a reconstrução tridimensional do esqueleto fetal por RM, com base em uma aquisição volumétrica da sequência VIBE modificada em todos os exames de RM do esqueleto fetal. Conclusão: Uma avaliação detalhada do esqueleto fetal pelas reconstruções tridimensionais realizadas após a aquisição da imagem usando sequência de RM VIBE modificada permitiu uma avaliação completa do esqueleto fetal, entretanto, as melhorias nessas sequências devem ser o foco de estudos futuros.

Evaluation of the fetal abdomen by magnetic resonance imaging. Part 2: abdominal wall defects and tumors.

Although ultrasound is still the gold standard for the assessment of fetal malformations, magnetic resonance imaging (MRI) has gained great prominence in recent years. In situations in which ultrasound has low sensitivity, such as maternal obesity, abdominal scarring, and oligohydramnios, MRI has proven to be a safe and accurate method. Regarding fetal abdominal wall defects, MRI appears to be widely used in the prognostic assessment of gastroschisis with intestinal atresia or of complications of omphalocele, allowing better perinatal management and parental counseling. In addition, MRI allows the assessment of local invasion of fetal abdominal tumors, with significant prognostic value for the postnatal period. In this article, we review the main MRI findings in the evaluation of fetal abdominal wall defects and tumors.