Purpose or Case Report: With the increasing utilization of imaging in prenatal diagnosis, the fetal MR appearance of omphalocele has been well-described. However, as fetal MR plays a critical role not only for diagnosis but also for planning and family counseling, the radiologist is required to risk stratify the range of presentations of this anomaly. There is a broad spectrum of severity within this single diagnosis: ranging from a small and covered bowel-only defect, to a large and ruptured multi-organ hernia, to a complex omphalocele within a nonkaryotype fetal syndrome. Outcomes are highly variable, ranging from a simple hernia repaired with primary closure, to a protracted postnatal course with staged surgical repairs, to expected intrapartum demise. Further, neonatal pulmonary hypoplasia and hypertension often complicate more severe cases. Thus, accurate prognostication is essential to properly equip and prepare families, and thereby add value to perinatal care.

In this presentation, we outline a 7-point, systematic method for analyzing the varied presentations of omphalocele, as seen on both 1.5T and 3T MR field strengths. The approach we describe details the following diagnostic criteria: (1) the size of the defect, (2) type and volume of herniated organ contents, (3) presence/absence of an intact membrane, (4) presence/absence of hernia sac ascites, (5) associated pulmonary hypoplasia, (6) insertion of the umbilical cord, and (7) presence of irregular cord vessels. Finally, we demonstrate how this diagnosis can correlate with associated ischemic changes in the placenta, a finding which can further aid delivery planning and prognostication.

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