Purpose or Case Report: Magnetic resonance imaging (MRI) is an increasingly utilized tool for evaluating congenital anomalies of the fetus. While the utility of fetal MRI has most thoroughly been described for assessment of the fetal central nervous system, it is progressively used for imaging anomalies of the chest, abdomen and pelvis. Because of the high inherent tissue contrast and its varied sequences, MRI can provide valuable information about the fetus and has been shown to assist parental counseling as well as prenatal and postnatal management. MRI protocols should be tailored to the specific clinical question at hand, which requires effective integration of pediatric radiologists within the fetal therapy team. The purpose of this educational exhibit is to highlight the role of fetal MRI in evaluating various congenital anomalies of the fetal chest, abdomen and pelvis, and discuss how fetal MRI findings may influence prenatal counseling and management.
Methods & Materials: We reviewed the fetal MRIs that were obtained at our institution in the last ten years. All mothers were consented prior to imaging. Each fetal MRI examination was performed under the supervision of a pediatric radiologist. Standard protocol for a fetal MRI consisted of triplanar TRUFISP orthogonal to the pelvis of the mother and subsequent triplanar T2-HASTE images adapted to the position of the fetus. Additional sequences, including T1-weighted images, diffusion weighted imaging, MR-fetography or susceptibility-weighted images were obtained as needed.
Results: Fetal MRI and correlative fetal ultrasound images from illustrative cases such as, but not limited to, congenital diaphragmatic hernia, congenital pulmonary airway malformation, omphalocele, OEIS complex, and sacrococcygeal teratoma will be shown to highlight the various ways fetal MRI affected parental counseling, fetal treatment and post-natal management.
Conclusions: This case-based educational exhibit will emphasize the importance of adapting the MRI technique to specific clinical contexts in order to gain the most critical information about the fetus. By approaching fetal MRI this way, the pediatric radiologist can truly complement the prenatal workup to support the most comprehensive prenatal evaluation. Fetal MRI should be viewed as a potentially crucial component of the overall evaluation of the fetal body, which can play an important role in prenatal counseling, fetal treatment and management.