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Fetal Thoracic Abnormalities: MR Imaging¹

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).

View larger version (158K): [in a new window]   Figure 1. A, B, Transverse and, C, coronal half-Fourier single-shot turbo spin-echo MR images (4.2-msec echo spacing, 60-msec effective echo time, echo train length of 72, one signal acquired, 4-mm section thickness, 32 x 32-cm field of view, and 192 x 256 matrix) obtained in a fetus at 34 weeks gestation with heterotaxy: right-sided stomach (S) and left-sided heart (h). Polysplenia (arrows in A) and two vessels are anterior to the spine, aorta (Ao), and azygous vein (Av); these findings are consistent with azygous continuation of the inferior vena cava. The esophagus (E) also is visualized. C, Coronal view shows bilateral high-signal-intensity hyparterial bronchi (arrowheads).

View larger version (12K): [in a new window]   Figure 2. Lung signal intensity plotted according to gestational age in fetuses with normal lungs. Lung signal intensity on T2-weighted MR images was graded by using a five-point scale as follows: 1 meant signal intensity as high as that of fluid (for comparison, amniotic fluid or cerebrospinal fluid at a similar distance from the coil); 2, signal intensity slightly lower than that of fluid; 3, signal intensity intermediate between that of fluid and that of muscle; 4, signal intensity slightly higher than that of muscle; and 5, signal intensity similar to that of muscle.

View larger version (107K): [in a new window]   Figure 3a. Changing appearance of CCAM. Sagittal half-Fourier single-shot fast spin-echo MR images (96-msec effective echo time, 40 x 40-cm field of view, 512 x 256 matrix, 3-mm section thickness) of a fetus at (a) 23 and (b) 34 weeks gestation. The lesion (arrow) is of high signal intensity at 23 weeks gestation but has shrunk to a small residual mass at 34 weeks gestation, at which time it is no longer visible at US (not shown).

View larger version (136K): [in a new window]   Figure 3b. Changing appearance of CCAM. Sagittal half-Fourier single-shot fast spin-echo MR images (96-msec effective echo time, 40 x 40-cm field of view, 512 x 256 matrix, 3-mm section thickness) of a fetus at (a) 23 and (b) 34 weeks gestation. The lesion (arrow) is of high signal intensity at 23 weeks gestation but has shrunk to a small residual mass at 34 weeks gestation, at which time it is no longer visible at US (not shown).

View larger version (114K): [in a new window]   Figure 4. Sagittal half-Fourier single-shot turbo spin-echo MR image (4.2-msec echo spacing, 60-msec effective echo time, echo train length of 72, one signal acquired, 4-mm section thickness, 30 x 30-cm field of view, and 192 x 256 matrix) of the chest of a fetus at 24 weeks gestation with a postnatal diagnosis of microgastria and gastroesophageal reflux. Fluid is seen in the esophagus (arrowhead) posterior to the trachea (arrow).