Mutambuze Jean,  Marine Megan

Final Pr. ID: Poster #: EDU-024

Fetal neck masses are a complex and diverse group of anomalies that can present diagnostic and management challenges for clinicians. In addition to prenatal ultrasound, fetal magnetic resonance imaging (MRI) has emerged as a powerful tool for the evaluation of these masses due to its high soft tissue contrast and ability to provide detailed anatomical information, especially with respect to the fetal airway and mediastinum. This educational exhibit explores the use of fetal MRI in the assessment of 7 different head and neck masses encountered at our institution, including providing a diagnostic approach, describing imaging features, and demonstrating the utility of fetal MRI in predicting the level of airway management the fetus may need, providing important implications for prenatal counseling and delivery management. Read More

Authors:  Mutambuze Jean , Marine Megan

Keywords:  Fetal Imaging, Fetal Masses, Fetal MRI

Elcic Lana,  Nashawaty Motassem,  Mousa Abeer,  Wermers Joshua

Final Pr. ID: Poster #: CR-014

Twin molar pregnancy featuring a complete hydatidiform mole and a coexisting live fetus is a rare but important condition with unique imaging findings. A 24-year-old pregnant female presented for concern for molar pregnancy on ultrasound at an outside facility. The gestational age of the pregnancy at presentation was 22 weeks and 6 days. MRI was obtained which revealed a single living fetus in cephalic presentation. Along the anterior and left lateral uterine body/fundus was a large lesion with multiple small discrete T2 hyperintense cysts intermixed with more solid T2 isointense components, as well as T2 hypointense, T1 hyperintense foci consistent with hemorrhagic products. The lesion was distinct and did not arise from the placenta. Same day ultrasound revealed a “snowstorm” appearance, consistent with twin molar pregnancy with a complete hydatidiform form and coexistent live fetus. Read More

Authors:  Elcic Lana , Nashawaty Motassem , Mousa Abeer , Wermers Joshua

Keywords:  Ultrasound and MRI, Fetal Imaging, Pregnancy

Prince Morgan,  Edwards Emily

Final Pr. ID: Poster #: CR-010

Infantile myofibromatosis (IM) is a rare congenital disease of early childhood. Approximately 50% of cases are diagnosed prenatally, and 90% are diagnosed prior to 2 years of age. Solitary IM, multicentric IM without visceral involvement, and generalized IM with cutaneous and visceral involvement have been described, with generalized IM carrying a poor prognosis and high mortality rate. The following reported case demonstrates an unusually high disease burden.
The patient was a monochorionic diamniotic twin fetus found to have a cystic and solid left facial mass on routine prenatal anatomy scan. Initial differential included congenital hemangioma, as well as lymphatic malformation and teratoma. Multiple prenatal ultrasounds and fetal MRI were obtained between gestational age 22w0d and delivery. At 32w2d, a new large paraspinal mass extending from the thoracic spine to the proximal right lower extremity was noted. During retrospective review, mild soft tissue thickening was noted in this region on fetal MRI. At this point, a vascular malformation was favored, with a differential of congenital rhabdomyosarcoma less likely. Ultrasound surveillance for the remainder of the pregnancy showed enlargement of the paraspinal mass with extension into the right retroperitoneal space.
The patient was delivered at 35w0d gestation via cesarean-section. On physical examination, she was found to have multiple masses involving the face, and the paraspinal, buttock, and bilateral lower extremity soft tissues. While atrophic papules were present, there were no overlying skin changes as would be expected with vascular malformations. Given the firmness of the masses and atrophic papules, the diagnosis of infantile myofibromatosis was suspected.
Whole-body MRI with contrast was obtained, demonstrating extensive heterogeneously enhancing soft tissue masses involving the left check, lower back extending into the retroperitoneal space, bilateral gluteal muscle and lower extremities.
The patient’s clinical status declined, and given the poor prognosis, was transitioned to comfort care and expired at age 2 months. Post-mortem autopsy confirmed the diagnosis of generalized infantile myofibromatosis with innumerable myofibromas of the right atrium, ventricles, intercostal muscle, diaphragm, thyroid, lungs, pancreas, adrenal glands, vertebrae, and paraspinal muscles.
The surviving twin is currently 2 years of age and is screened with whole-body MRI annually without evidence of disease. Read More

Authors:  Prince Morgan , Edwards Emily

Keywords:  Infantile Myofibromatosis, Fetal Imaging, Congenital

Illimoottil Mathew,  Errampalli Eric,  Kosaraju Sriya,  Illimoottil Sarah,  Leland Kristin

Final Pr. ID: Poster #: EDU-047

Urinary tract dilation (UTD) is a common finding in fetal and neonatal imaging, and accurate classification is essential for guiding management and determining prognosis. This educational exhibit provides a comprehensive review of the UTD classification system, with a focus on the findings on fetal ultrasound (US), fetal MRI and postnatal imaging. In addition to the classification system, we will explore the etiologies of UTD, including obstructive and non-obstructive causes such as vesicoureteral reflux, ureteropelvic junction obstruction, and posterior urethral valves. Special emphasis will be placed on the role of prenatal and postnatal imaging in monitoring progression and guiding management decisions, including when surgical intervention may be necessary. We aim to enhance the understanding of the diagnostic criteria for UTD, provide insight into the correlation between imaging findings and clinical outcomes, and equip pediatric radiologists with the tools to make informed management recommendations. This review will aid in the accurate diagnosis and treatment of UTD, ultimately improving outcomes for affected neonates. Read More

Authors:  Illimoottil Mathew , Errampalli Eric , Kosaraju Sriya , Illimoottil Sarah , Leland Kristin

Keywords:  Urinary Tract Dilation, UTD Classification, Fetal Imaging

Aboughalia Hassan,  Dighe Manjiri

Final Pr. ID: Poster #: EDU-010

Fetal lung maturity is a key factor determining perinatal morbidity and mortality. Clinicians can perform amniocentesis and evaluate the amniotic fluid for certain surfactant byproducts such as lethicin, sphingomyelin, and phosphatidylglycerol to assess lung maturity. However, amniocentesis is invasive, and its results can be prone to errors. Imaging can offer a reliable non-invasive alternative that can be used for prognostication as well as suggestion of further follow up. Ultrasound is the imaging modality of choice to assess fetal development. It is readily available on widespread scale to assess for various abnormalities that can occur during pregnancy. Parameters used to assess fetal lung maturity on ultrasound include lung to head ratio as well as the observed/expected lung to head ratio. However, ultrasound parameters can be subjective, have inter- and intra-observer variability and depend highly on the imaging technique and quality. The advent of ultrafast MRI sequences expanded its use in fetal imaging offering an alternative to ultrasound. It is generally used as a problem-solving tool due its excellent soft tissue resolution. Two parameters are gaining acceptance as means to assess fetal lung development on MRI: lung volume measurements and lung/liver signal intensity ratio. Our exhibit aims at familiarizing pediatric radiologists with parameters used to assess lung development on both ultrasound and MRI. Read More

Authors:  Aboughalia Hassan , Dighe Manjiri

Keywords:  Lung maturity, Fetal Imaging

Gwal Kriti,  Malik Archana,  Neville Kucera Jennifer,  Saul David

Final Pr. ID: Poster #: CR-013

To present an extremely rare case of fetus in fetu which was discovered with prenatal ultrasound and fetal MR. Read More

Authors:  Gwal Kriti , Malik Archana , Neville Kucera Jennifer , Saul David

Keywords:  Fetal Imaging, Fetal Magnetic Resonance Imaging, Prenatal Imaging

Vansyckel Arielle,  Brown Brandon

Final Pr. ID: Poster #: EDU-016

Midface anomalies in the fetus can present with a range of severity and corresponding neonatal morbidity, on a spectrum from cosmetic disturbance to airway obstruction. Immediate postpartum complications include life-threatening hypoxia and feeding disturbances. These anomalies not only present immediate difficulties but also often exist within a variety of syndromes with long-term consequences, affecting various organ systems. While screening ultrasound frequently can identify deviations from normal, fetal MRI may provide more detailed and high-resolution imaging for the characterization of midface anomalies and associated prenatal disease.
The identification of facial anomalies in utero should prompt further investigation for associated abnormalities, and will also allow for improved prenatal counseling, which can prepare parents for the immediate postpartum management including surgical planning and resource allocation. It furthermore provides a foundation to shape family expectations and to begin to frame psychosocial support, allowing parents to engage mentally and emotionally with the medical and surgical course that awaits.

In this presentation, we highlight the normal fetal midface as seen on MRI at various stages of development, and outline a systematic approach for evaluation of the fetal midface structures. Recognition of this typical appearance will allow the radiologist to identify the range of possible abnormalities that can occur and which can shape prognosis when properly identified. Various cases of midface anomalies will be reviewed and linked to their clinical significance, including cases with associated intracranial anomalies and deficiencies in swallowing and respiration. Read More

Authors:  Vansyckel Arielle , Brown Brandon

Keywords:  Fetal imaging, Midface anomaly

Creeden Sean,  Dahmoush Hisham,  Guimaraes Carolina

Final Pr. ID: Poster #: EDU-079

Brainstem anomalies pose a diagnostic challenge for trainees to even the most advanced in their practice. Our exhibit aims to provide a comprehensive review of these rare disorders which are being diagnosed earlier and more frequently utilizing advanced imaging and genetic sequencing techniques. Representative images of these disorders with key distinguishing features will be presented. Familiarity with these conditions will benefit practicing radiologists, radiologists in training, and our clinical colleagues. Read More

Authors:  Creeden Sean , Dahmoush Hisham , Guimaraes Carolina

Keywords:  fetal imaging, neuroradiology, MRI