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Obstetric Imaging |
1 From the Departments of Radiology (D.L., T.M.) and Obstetrics and Gynecology (D.L., G.W.), Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215; Department of Radiology and the Advanced Fetal Care Center, Children’s Hospital, Boston, Mass (C.E.B., J.E.); and Department of Radiology, Hôpital Saint-Luc, Centre hospitalier de l’Universite de Montreal, Rue St-Denis, Montreal, Quebec, Canada (I.T.). Received May 20, 2002; revision requested July 16; final revision received November 25; accepted December 16. Supported in part by National Institutes of Health grant NS37945. Address correspondence to D.L. (e-mail: dlevine@caregroup.harvard.edu).
PURPOSE: To elucidate the appearance of fetal thoracic abnormalities at prenatal magnetic resonance (MR) imaging and determine whether MR imaging yields information additional to that obtained with ultrasonography (US).
MATERIALS AND METHODS: US and MR imaging data from 83 MR examinations of 74 fetuses with thoracic abnormalities and confirmatory US performed within 1 week before MR imaging were compared with respect to resulting changes in patient counseling and/or care. Lung parenchyma and lesion signal intensities and vascularity, airway, esophagus, and diaphragm appearances were reviewed retrospectively on MR images. Student t tests and analyses of variance were performed.
RESULTS: MR imaging yielded information additional to that acquired with US in 28 (38%) of 74 fetuses. The additional findings were confirmed in 19 of the 28 fetuses at postnatal follow-up; no follow-up data were available for the other nine fetuses. Thoracic MR information affected care with regard to six (8%) of 74 fetuses. Mean gestational age of 15 fetuses with lung signal intensity (SI) slightly lower than that of amniotic fluid (28.4 weeks ± 6.8 [SD]) at T2-weighted MR imaging was significantly older than that of 18 fetuses with intermediate SI (21.3 weeks ± 4.3) (P < .05). Mean SI of 13 congenital cystic adenomatoid malformations (CCAMs) and/or sequestrations (1.74 ± 1.05) at T2-weighted MR imaging was significantly higher than that of the normal lungs of 33 fetuses (2.63 ± .63) (P < .001). Among nine studies in which vessels were visualized in CCAMs and/or sequestrations, six involved a normal vascular branching pattern. Portions of the esophagus were seen in 31 (36%) of 85 fetuses. Nonvisualization of a major airway was not sufficient for diagnosis of pulmonary atresia. Visualization of a portion of the esophagus did not correlate with esophageal atresia. In all except one fetus, who had anhydramnios and pulmonary hypoplasia, and the fetuses with congenital diaphragmatic hernia, at least a portion of the diaphragm was visualized at MR imaging.
CONCLUSION: MR imaging yields information additional to that yielded with US in fetuses with thoracic abnormalities.
© RSNA, 2003
Index terms: Fetus, abnormalities, 856.8721, 856.875 • Fetus, cardiovascular system, 856.8751 • Fetus, MR, 856.121411, 856.121412, 856.121413, 856.121416 • Fetus, respiratory system, 856.8754, 856.8755, 856.8756, 856.8758 • Fetus, US, 856.129
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