Purpose or Case Report: Fetal MRI is now an important adjunct imaging modality in the evaluation of complex fetal anomalies, including cystic renal disease. The improved resolution and anatomic detail of the renal parenchyma offered by MRI can assist with identification, localization, and characterization of cystic lesions which are less clearly visualized on ultrasound. Advanced imaging adds value through enabling prenatal prognostication and patient counseling. In this presentation, we evaluate the spectrum of renal cystic abnormalities at the microscopic and macroscopic scale, and review the patterns of disease by cyst location, effect on parenchymal integrity, and obstruction of the collecting system. A clearer understanding of the diverse appearances and broad spectrum of outcomes of these fetal anomalies can contribute to more detailed treatment planning and more precise, family-centered care.
In this presentation, we review the varied patterns of cystic renal disease as identified on fetal MRI, highlighting those forms known to be more associated with perinatal morbidity and mortality. Further, we correlate their appearance on MRI with pre- and post-natal US imaging, as well as pathologic findings. Finally, we will describe secondary prenatal imaging biomarkers that may be valuable in counseling and also with both definitive and palliative surgical planning.

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