Purpose or Case Report: Congenital diaphragmatic hernia (CDH) is a life-threatening fetal anomaly characterized by herniation of abdominal contents into the thoracic cavity due to a defect in the diaphragm, most commonly left-sided. Accurate prenatal diagnosis and risk stratification are essential for guiding perinatal management, parental counseling, and prognostication. While ultrasound remains the first-line modality for initial detection, fetal MRI provides superior soft tissue contrast and volumetric assessment, offering critical additional information, particularly in complex or equivocal cases. This educational exhibit serves as a practical guide for radiologists interpreting fetal MRI for CDH. We review the typical imaging features of CDH on MRI, including identification of herniated organs, mediastinal shift, and assessment of the ipsilateral and contralateral lungs. Emphasis is placed on the standardized approach to measuring total and observed-to-expected lung volumes (o/e TLV), as well as lung area to head cicumference ratio (LHR), which serve as key prognostic markers. The exhibit also addresses the significance of liver position, stomach location, and diaphragmatic defect size, all of which correlate with postnatal outcomes and surgical complexity. We illustrate how MRI findings influence the clinical decision-making process, including eligibility for fetal intervention such as fetoscopic endoluminal tracheal occlusion (FETO). Radiologists play a vital role in the multidisciplinary care of these patients by providing accurate and reproducible measurements that impact prognosis and management. This exhibit aims to equip radiologists with the essential tools and knowledge required to confidently evaluate CDH on fetal MRI and contribute meaningfully to perinatal planning.
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