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Fetal Anomalies: Comparison of MR Imaging and US for Diagnosis¹

¹ From the Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115 (M.C.F., A.J.K., C.B.B., C.M.T.); and Department of Radiology, Children’s Hospital, Harvard Medical School, Boston, Mass (V.L.W.). From the 1999 RSNA scientific assembly. Received April 3, 2003; revision requested June 20; revision received November 3; accepted December 9. Address correspondence to M.C.F. (e-mail: mfrates@partners.org).

View larger version (56K): [in a new window]   Figure 1. Schema shows comparison of US and MR imaging findings for cases in which MR imaging added no information and for those in which MR imaging added information to final diagnosis. Findings were confirmed at postnatal final diagnosis.

View larger version (58K): [in a new window]   Figure 2. Schema shows comparison of US and MR imaging findings; diagnosis was incorrect with at least one modality when findings were compared with postnatal final diagnosis. Findings that occurred in the same fetus are indicated (*).

View larger version (200K): [in a new window]   Figure 3a. Dandy-Walker variant in 18-week fetus. (a) Transverse US image of fetal posterior fossa demonstrates cleft (arrow) between cerebellar hemispheres. (b) Transverse T2-weighted single-shot fast spin-echo MR image of the fetal brain 8 days later shows cleft (arrow) between cerebellar hemispheres and confirms partial absence of the vermis.

View larger version (196K): [in a new window]   Figure 3b. Dandy-Walker variant in 18-week fetus. (a) Transverse US image of fetal posterior fossa demonstrates cleft (arrow) between cerebellar hemispheres. (b) Transverse T2-weighted single-shot fast spin-echo MR image of the fetal brain 8 days later shows cleft (arrow) between cerebellar hemispheres and confirms partial absence of the vermis.

View larger version (187K): [in a new window]   Figure 4a. Intracranial hemorrhage in 28-week fetus. (a) Transverse US image of fetal head shows mild ventriculomegaly (calipers) with echogenic material (arrows); findings were consistent with clot in dependent left lateral ventricle and adjacent parietal lobe. Nondependent ventricle is obscured by shadowing from fetal skull. (b) Transverse T2-weighted single-shot fast spin-echo MR image of fetal head obtained later the same day confirms presence of hemorrhage (arrows) in left cerebral parenchyma. Intraventricular clot was also confirmed on other images. (c) Postnatal sagittal US image of left lateral ventricle demonstrates porencephalic cyst (arrows) and irregularity of ventricular wall. (d) Postnatal transverse T2-weighted single-shot fast spin-echo MR image of brain shows focal dilatation of dependent left lateral ventricle, as well as hemosiderin deposition (arrows) along lateral aspect of ventricle.

View larger version (176K): [in a new window]   Figure 4b. Intracranial hemorrhage in 28-week fetus. (a) Transverse US image of fetal head shows mild ventriculomegaly (calipers) with echogenic material (arrows); findings were consistent with clot in dependent left lateral ventricle and adjacent parietal lobe. Nondependent ventricle is obscured by shadowing from fetal skull. (b) Transverse T2-weighted single-shot fast spin-echo MR image of fetal head obtained later the same day confirms presence of hemorrhage (arrows) in left cerebral parenchyma. Intraventricular clot was also confirmed on other images. (c) Postnatal sagittal US image of left lateral ventricle demonstrates porencephalic cyst (arrows) and irregularity of ventricular wall. (d) Postnatal transverse T2-weighted single-shot fast spin-echo MR image of brain shows focal dilatation of dependent left lateral ventricle, as well as hemosiderin deposition (arrows) along lateral aspect of ventricle.

View larger version (144K): [in a new window]   Figure 4c. Intracranial hemorrhage in 28-week fetus. (a) Transverse US image of fetal head shows mild ventriculomegaly (calipers) with echogenic material (arrows); findings were consistent with clot in dependent left lateral ventricle and adjacent parietal lobe. Nondependent ventricle is obscured by shadowing from fetal skull. (b) Transverse T2-weighted single-shot fast spin-echo MR image of fetal head obtained later the same day confirms presence of hemorrhage (arrows) in left cerebral parenchyma. Intraventricular clot was also confirmed on other images. (c) Postnatal sagittal US image of left lateral ventricle demonstrates porencephalic cyst (arrows) and irregularity of ventricular wall. (d) Postnatal transverse T2-weighted single-shot fast spin-echo MR image of brain shows focal dilatation of dependent left lateral ventricle, as well as hemosiderin deposition (arrows) along lateral aspect of ventricle.

View larger version (130K): [in a new window]   Figure 4d. Intracranial hemorrhage in 28-week fetus. (a) Transverse US image of fetal head shows mild ventriculomegaly (calipers) with echogenic material (arrows); findings were consistent with clot in dependent left lateral ventricle and adjacent parietal lobe. Nondependent ventricle is obscured by shadowing from fetal skull. (b) Transverse T2-weighted single-shot fast spin-echo MR image of fetal head obtained later the same day confirms presence of hemorrhage (arrows) in left cerebral parenchyma. Intraventricular clot was also confirmed on other images. (c) Postnatal sagittal US image of left lateral ventricle demonstrates porencephalic cyst (arrows) and irregularity of ventricular wall. (d) Postnatal transverse T2-weighted single-shot fast spin-echo MR image of brain shows focal dilatation of dependent left lateral ventricle, as well as hemosiderin deposition (arrows) along lateral aspect of ventricle.

View larger version (171K): [in a new window]   Figure 5a. Degenerative disease of posterior fossa in 34-week fetus. (a) Transverse US image of fetal head. Shadowing (S) from fetal skull obscures most of the intracranial anatomy, and late gestational age caused decrease in image quality. Posterior fossa, including the cerebellum (arrowheads) and cisterna magna (*), appears grossly normal. (b) Sagittal T2-weighted single-shot fast spin-echo MR image of fetal brain. Fetal face is to the right. Cerebellum (arrow) and brainstem (arrowheads) are markedly hypoplastic, and these findings are consistent with pontine cerebellar degeneration.

View larger version (157K): [in a new window]   Figure 5b. Degenerative disease of posterior fossa in 34-week fetus. (a) Transverse US image of fetal head. Shadowing (S) from fetal skull obscures most of the intracranial anatomy, and late gestational age caused decrease in image quality. Posterior fossa, including the cerebellum (arrowheads) and cisterna magna (*), appears grossly normal. (b) Sagittal T2-weighted single-shot fast spin-echo MR image of fetal brain. Fetal face is to the right. Cerebellum (arrow) and brainstem (arrowheads) are markedly hypoplastic, and these findings are consistent with pontine cerebellar degeneration.

View larger version (113K): [in a new window]   Figure 6a. Sacrococcygeal teratoma in 25.5-week fetus. (a) Sagittal US image of sacral spine demonstrates large heterogeneous mass (arrowheads) that protrudes from base of spine, consistent with sacrococcygeal teratoma. There were no sonographic signs of hydrops. (b) Oblique T2-weighted single-shot fast spin-echo MR image obtained earlier the same day shows heterogeneous teratoma (arrowheads). Subcutaneous fluid (arrows) is seen as high-signal-intensity area under skin of fetal chest, back, and abdomen; this finding indicates early hydrops. Five days after these images were acquired, fetal demise occurred.

View larger version (193K): [in a new window]   Figure 6b. Sacrococcygeal teratoma in 25.5-week fetus. (a) Sagittal US image of sacral spine demonstrates large heterogeneous mass (arrowheads) that protrudes from base of spine, consistent with sacrococcygeal teratoma. There were no sonographic signs of hydrops. (b) Oblique T2-weighted single-shot fast spin-echo MR image obtained earlier the same day shows heterogeneous teratoma (arrowheads). Subcutaneous fluid (arrows) is seen as high-signal-intensity area under skin of fetal chest, back, and abdomen; this finding indicates early hydrops. Five days after these images were acquired, fetal demise occurred.