Is there a role for magnetic resonance imaging in cesarean scar pregnancy after the first trimester?

Magnetic resonance imaging (MRI) can provide additional information in cases of cesarean scar pregnancy beyond the first trimester. MRI and 3D reconstructions can demonstrate the relationships between the uterus, cervix, bladder, and placenta, improving the spatial perspective of the pelvic anatomy in cases requiring surgical management. MRI and 3D reconstructions can also provide more comprehensive images for parental counseling, virtual and face-to-face multidisciplinary team discussion, and medical record storage.

Prenatal diagnosis of closed gastroschisis: What to expect in the most severe form of gastroschisis? Case report and literature review.

Closed gastroschisis (CG) and vanishing gastroschisis (VG) are the most severe forms of evolution of the malformation. In this case, a fetus presented with gastroschisis at 13 weeks, and the gastroschisis was not visualized at 22 weeks of gestation. Distal ileum, cecum, and ascending colon atresia were diagnosed at surgery, and the child is fully enteral-fed at 5 months of age. In a literature review of 43 cases of prenatal diagnosis of CS-VG, intrauterine death occurred in 4.5% of cases. 79.6% of the cases underwent surgical treatment. Of these cases, 20% of cases died due to complications of treatment, 26% were still under treatment and 54% are alive with enteral feeding. In 77% of the cases, the closure of the umbilical ring occurred after 26 weeks of gestation and the absence of prenatal diagnosis of CG-VG during pregnancy has a risk of 71% of death.

Virtual segmentation of three-dimensional ultrasound images of morphological structures of an ex vivo ectopic pregnancy inside a fallopian tube.

Ex vivo ultrasound (US) of human tissues has been used for decades on the study of the acoustic physical aspects of the US, to the study of the morphology of the organs. Using three-dimensional (3D) US, we demonstrate the possibilities to study surgical specimens from gynecological conditions. 3D images of the surgical specimen were collected and virtually segmented according to the contrast of its images, providing a 3D image of the ectopic pregnancy and its effects on the fallopian tube.

Venolymphatic malformations: prenatal diagnosis using magnetic resonance imaging, perinatal outcomes and long-term follow-up.

BACKGROUND: Venolymphatic malformations are benign. Fetal MRI can more precisely demonstrate an infiltrative pattern of malformations than US. OBJECTIVE: To evaluate perinatal outcomes and long-term follow-up of fetal venolymphatic malformations treated in different medical facilities using fetal MRI. MATERIALS AND METHODS: This retrospective cohort study evaluated 20 pregnant women between 22 weeks and 37 weeks of gestation who were referred from different institutions. They presented with fetuses with various diagnoses of cystic masses on routine US. The cases were studied using MRI. We analyzed prenatal data, perinatal outcomes and long-term follow-up. RESULTS: We reviewed the MRI scans of 20 patients with venolymphatic malformation. Referral diagnosis was changed in 40% (8/20) of cases, with postnatal concordance of 100% (20/20). Moreover, 65% (13/20) presented with venolymphatic malformation in more than one body segment. The neck was affected in 70% (14/20) of fetuses, while the head and thorax were affected in 30% (6/20) and 45% (9/20), respectively. There were intrathoracic lesions in 35% (7/20), lesions in the abdomen in 30% (6/20), and lesions in the perineum and extremities in 10% (2/20) each. Tracheal displacement, neck deflection and anatomical displacement caused by tumoral compression were present in 15% (3/20) of cases. Moreover, 25% (5/20) of newborns required neonatal intensive care unit admission, and all presented with cervical or thoracic venolymphatic malformation. Furthermore, 50% (10/20) of cases presented with complete resolution after medical therapy. The intrathoracic and cervical residuals (35%, 7/20) were monitored and treated. CONCLUSION: MRI showed good correlation with postnatal examination of venolymphatic malformation, was useful in the differential diagnosis of fetal cysts on US, and presented a significant postnatal correlation with thoracic infiltration. The outcomes of prenatally diagnosed venolymphatic malformations are good despite the varying protocols among medical facilities.

Congenital Duodenal Stenosis: Prenatal Evaluation by Three-dimensional Ultrasound HDlive Silhouette Mode, Magnetic Resonance Imaging, and Postnatal Outcomes.

The "double bubble" sign is a common sign of congenital duodenal obstruction (CDO), which has been detected during prenatal diagnosis for over 40 years. CDO is strongly associated with chromosomal and structural abnormalities and encompasses a wide spectrum of diagnoses. Here, we describe a case of duodenal stenosis, a rare cause of duodenal obstruction, which was suspected using conventional two-dimensional ultrasound and three-dimensional reconstruction with the HDlive silhouette mode at the 28th prenatal week. The suspicion was further supported by magnetic resonance imaging performed at the 32nd prenatal week and confirmed by postnatal surgery.

The human endosalpinx: anatomical three-dimensional study and reconstruction using confocal microtomography.

PURPOSE: To evaluate in three dimensions (3D) the human endosalpinx and reconstruct its surface along its different anatomical segments, without the injection or insertion of luminal contrasts, using confocal microtomography (micro-CT). MATERIAL AND METHODS: 15 fallopian tubes (FT) from 14 women in reproductive age from procedures for benign disease or sterilization were selected. The specimens were fixed in formalin and stained with Lugol solution. Micro-CT studies were conducted on the specimens using protocols adapted from biological studies, to acquire images to reconstruct in 3D the endosalpinx surface. RESULTS: From these specimens, 6 presented the intra-mural segment, 14 presented the isthmus and 15 presented the ampulla and fimbria segment of the FT. The specimen presented tissue definition, and contrast sufficient for FT endosalpinx morphological analysis and lumen definition. The intramural portion presented initially a mucosal projection toward the lumen, bending on its own axis, and increased numbers of projections towards the isthmic portion, where the projections become longer more numerous. The endosalpinx becomes more tortuous, the lumen diameter increases and the mucosal projections become more bulky in the ampullary portion, with the projections less present on the antimesenteric side. The infundibular portion is marked with the organized and predictable endosalpinx, the abdominal ostium is cleared demonstrated, with the reduction of the endosalpinx volume. The fimbria demonstrated a small relation between fringes and intratubal endosalpinx. CONCLUSIONS: Microscopic anatomy of different segments of the human FT mucosa can be analyzed and reconstructed in 3D with histological correlation using micro-CT.

Tuboperitoneal fistula, ectopic pregnancy, and remnants of fallopian tube: a confocal microtomography analysis and 3D reconstruction of human fallopian tube pathologies.

Objective: The aim of this study was to provide a three-dimensional (3D) microscopic reconstruction of morphological modifications of the fallopian tube (FT) following surgical sterilization (including tuboperitoneal fistula) and ectopic pregnancy (EP) using confocal microtomography (micro-CT). Methods: Six specimens of FT from elective and emergency surgeries were selected: three remnants of the FT (RFT) from surgical sterilization, including one presenting tuboperitoneal fistula, and three FTs with EP. The specimens were fixed in formalin and stained with Lugol solution. Micro-CT studies were conducted on the specimens using protocols adapted from biological studies. Results: Three RFTs from surgical sterilization and three FTs affected by EPs were successfully scanned using micro-CT. There was good contrast impregnation, allowing tissue segmentation and analysis of different sections of the FTs. Three FT specimens from EP exhibited considerable distortion of the tubal anatomy, mainly from the blood clot in the tubal abortion. Three RFT specimens exhibited some features observed in traditional microscopy, such as tubal distension and loss of normal anatomical characteristics of a normal FT, and indicated the presence of a tuboperitoneal fistula in one of the three specimens. Conclusion: Micro-CT can identify morphological characteristics of FT pathologies previously described in a microscopic scale, with tissue contrast and the possibility of 3D reconstruction. Micro-CT is also useful in guiding traditional sectioning of specimens for histopathological studies.

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.

Evaluation of the fetal abdomen by magnetic resonance imaging. Part 2: abdominal wall defects and tumors / Avaliação do abdome fetal por ressonância magnética. Parte 2: malformações da parede abdominal e tumores

Abstract 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.

Resumo Apesar de a ultrassonografia (US) ser o método padrão ouro na avaliação das malformações fetais, a ressonância magnética (RM) tem ganhado grande destaque nos últimos anos. Em algumas situações nas quais a US apresenta baixa sensibilidade, como obesidade materna, cicatrizes abdominais e oligo-hidrâmnio, a RM mostra-se um método seguro e com boa acurácia. Em relação às malformações da parede abdominal fetal, a RM mostra-se usual na avaliação prognóstica da atresia intestinal da gastrosquise ou complicações da onfalocele, permitindo melhor manejo perinatal e aconselhamento dos pais. Da mesma forma, a RM possibilita a avaliação de invasão local de tumores abdominais fetais, apresentando valor prognóstico pós-natal. Neste artigo, abordamos os principais achados na RM das malformações da parede abdominal fetal e tumores.

Evaluation of the fetal abdomen by magnetic resonance imaging. Part 1: malformations of the abdominal cavity.

Although ultrasound continues to be the mainstay modality for the evaluation of fetal disorders, fetal magnetic resonance imaging (MRI) has often been used as a valuable adjunct in recent years. The exponential growth of the use of fetal MRI has been facilitated by technological advancements such as ultrafast T2-weighted sequences and diffusion-weighted imaging. Fetal MRI can achieve results that are comparable to or better than those of ultrasound, particularly in cases of maternal obesity, severe oligohydramnios, or abnormal fetal position. Because of its superior soft tissue contrast, wide field of view, and multiplanar imaging, fetal MRI is able to evaluate the large fetal organs, such as the lungs, liver, bowel, and kidneys. In addition, fetal MRI allows large or complex malformations to be examined, facilitating the understanding of the malformation within the context of the body as a whole. Initial fetal MRI studies were focused on the central nervous system. With advances in software and hardware, fetal MRI gained importance in the evaluation of the fetal abdomen. The purpose of this article is to review the recent literature and developments in MRI evaluation of the fetal abdomen, with an emphasis on imaging aspects, protocols, and common clinical indications.

Apesar de a ultrassonografia (US) permanecer como principal método na avaliação de desordens fetais, a ressonância magnética (RM) fetal tem sido frequentemente usada como método adjuvante nos últimos anos. O crescente uso da RM fetal foi facilitado pelos avanços tecnológicos como a sequência pesada em T2 ultrarrápida e imagens diffusion-weighted. A RM fetal pode alcançar resultados superiores ou semelhantes aos da US, principalmente em casos de obesidade materna, oligo-hidrâmnio ou posição fetal anômala. Por apresentar melhor contraste entre tecidos, grande campo de visão e cortes multiplanares, a RM fetal é capaz de avaliar órgãos fetais de grande volume como pulmões, fígado, cólon e rins. Ademais, a RM fetal permite o exame de malformações grandes ou complexas, facilitando a compreensão da malformação no contexto de todo o corpo fetal. Inicialmente, os estudos eram direcionados ao sistema nervoso central. Com o avanço dos softwares e hardwares, a RM fetal ganhou importância na avaliação da cavidade do abdome fetal. O propósito deste artigo é revisar a literatura recente e avanços na avaliação da cavidade abdominal fetal pela RM, com ênfase nas características das imagens, protocolos e indicações clínicas mais comuns.

Evaluation of the fetal abdomen by magnetic resonance imaging. Part 1: malformations of the abdominal cavity / Avaliação do abdome fetal por ressonância magnética. Parte 1: malformações da cavidade abdominal

Abstract Although ultrasound continues to be the mainstay modality for the evaluation of fetal disorders, fetal magnetic resonance imaging (MRI) has often been used as a valuable adjunct in recent years. The exponential growth of the use of fetal MRI has been facilitated by technological advancements such as ultrafast T2-weighted sequences and diffusion-weighted imaging. Fetal MRI can achieve results that are comparable to or better than those of ultrasound, particularly in cases of maternal obesity, severe oligohydramnios, or abnormal fetal position. Because of its superior soft tissue contrast, wide field of view, and multiplanar imaging, fetal MRI is able to evaluate the large fetal organs, such as the lungs, liver, bowel, and kidneys. In addition, fetal MRI allows large or complex malformations to be examined, facilitating the understanding of the malformation within the context of the body as a whole. Initial fetal MRI studies were focused on the central nervous system. With advances in software and hardware, fetal MRI gained importance in the evaluation of the fetal abdomen. The purpose of this article is to review the recent literature and developments in MRI evaluation of the fetal abdomen, with an emphasis on imaging aspects, protocols, and common clinical indications.

Resumo Apesar de a ultrassonografia (US) permanecer como principal método na avaliação de desordens fetais, a ressonância magnética (RM) fetal tem sido frequentemente usada como método adjuvante nos últimos anos. O crescente uso da RM fetal foi facilitado pelos avanços tecnológicos como a sequência pesada em T2 ultrarrápida e imagens diffusion-weighted. A RM fetal pode alcançar resultados superiores ou semelhantes aos da US, principalmente em casos de obesidade materna, oligo-hidrâmnio ou posição fetal anômala. Por apresentar melhor contraste entre tecidos, grande campo de visão e cortes multiplanares, a RM fetal é capaz de avaliar órgãos fetais de grande volume como pulmões, fígado, cólon e rins. Ademais, a RM fetal permite o exame de malformações grandes ou complexas, facilitando a compreensão da malformação no contexto de todo o corpo fetal. Inicialmente, os estudos eram direcionados ao sistema nervoso central. Com o avanço dos softwares e hardwares, a RM fetal ganhou importância na avaliação da cavidade do abdome fetal. O propósito deste artigo é revisar a literatura recente e avanços na avaliação da cavidade abdominal fetal pela RM, com ênfase nas características das imagens, protocolos e indicações clínicas mais comuns.

Prenatal Diagnosis of Caroli Disease Associated With Autosomal Recessive Polycystic Kidney Disease by 3-D Ultrasound and Magnetic Resonance Imaging.

BACKGROUND: Caroli disease is a very rare congenital anomaly characterized by non-obstructive saccular or fusiform dilatation of the intrahepatic bile ducts. It is associated with bile stagnation and hepatolithiasis, which explain the recurrent cholangitis and portal hypertension as a consequence of congenital liver fibrosis. Although there are several reports of diagnosis in childhood and adult life, the prenatal diagnosis using conventional 2-D ultrasound is rare, with few reports in the literature. CASE: We present a case of a 26-year-old primigravid woman at 24 weeks of gestation which 3-D ultrasound in the rendering mode clearly revealed the enlarged fetal kidneys and the increased abdominal volume, confirming the diagnosis of autosomal recessive polycystic kidney disease. The MRI was essential to the prenatal diagnosis of Caroli disease, identifying the congenital saccular dilations of intrahepatic bile ducts.