Barhaghi Krystle,  Schuchardt Eleanor,  Schafer Michal,  Meyers Mariana,  Behrendt Nicholas,  Barker Alex,  Cuneo Bettina,  Friesen Richard,  Browne Lorna

Final Pr. ID: Paper #: 102

Previous studies show that phase contrast MRI (PC-MRI) can successfully measure fetal blood flow in late gestation singleton fetuses. To date there is a paucity of data quantifying fetal blood flow of twin or early gestational age pregnancies (~19 weeks). Twin-twin transfusion syndrome (TTTS) is a rare complication of monochorionic pregnancies that is believed to result from inequal flow distribution between fetuses. In this novel investigation, we utilized PC-MRI to investigate fetal aortic flow in early gestational age fetuses with TTTS or selective Intrauterine Growth Restriction (sIUGR). We compared flow distribution between the smaller and larger fetus in each twin pair. Read More

Authors:  Barhaghi Krystle , Schuchardt Eleanor , Schafer Michal , Meyers Mariana , Behrendt Nicholas , Barker Alex , Cuneo Bettina , Friesen Richard , Browne Lorna

Keywords:  Fetal MRI, Twins, Phase Contrast MRI

Ayyala Rama,  Maddocks Alexis,  Anupindi Sudha,  Victoria Teresa

Final Pr. ID: Poster #: SCI-041

Intraabdominal cystic lesions are relatively common prenatal diagnoses. Determining its etiology and diagnosis can be challenging on prenatal imaging. Fetal MR is a helpful imaging modality that can provide additional anatomic and physiologic information. The purpose of this study is to evaluate MR imaging findings of fetal intraabdominal cystic lesions with correlation with postnatal imaging and outcome. Read More

Authors:  Ayyala Rama , Maddocks Alexis , Anupindi Sudha , Victoria Teresa

Keywords:  Fetal, MRI, Cyst

Lewis Heidi,  Kucera Jennifer

Final Pr. ID: Poster #: CR-033

Atretic cephalocele is a rare type of neural tube defect that occurs in the parietal or occipital scalp. Most cases present postnatally with a scalp nodule which may also have associated skin and hair abnormalities. We will present a case of atretic cephalocele diagnosed with fetal MRI as well as two additional cases of postnatally diagnosed atretic cephalocele in different patients.

A 26 week gestational age male fetus was found to have ventriculomegaly on routine OB ultrasound and was referred to maternal fetal medicine. Further ultrasound imaging demonstrated features suspicious for a posterior fossa encephalocele. A fetal MRI was then performed which demonstrated imaging findings consistent with an atretic cephalocele.

The imaging findings associated with atretic cephalocele including embryologic positioning of the straight sinus, the “spinning top” appearance of the tentorial incisura, and the “cigar shaped” CSF tract in the interhemispheric fissure will be illustrated in the exhibit using both fetal and postnatal MRI. Although the exact embryological development of atretic cephaloceles is not completely understood, the proposed mechanisms will be discussed. A brief summary of the associated syndromes and clinical outcomes reported in the literature will be presented.

Atretic cephalocele is a rare condition that is usually diagnosed postnatally with several characteristic imaging findings. These same abnormalities can also be seen on fetal MRI which can lead to an earlier diagnosis and more appropriate family counseling. Read More

Authors:  Lewis Heidi , Kucera Jennifer

Keywords:  atretic cephalocele, Fetal MRI

Priego Gema,  Hurteau-miller Julie,  Fontalvo Lucia,  Miller Elka

Final Pr. ID: Poster #: EDU-062

Describe the anatomy and regional difference in brain maturation of various brain structures comparing 3 and 1.5 Tesla fetal MRI.

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Authors:  Priego Gema , Hurteau-miller Julie , Fontalvo Lucia , Miller Elka

Keywords:  Fetal MRI

Bhargava Ravi,  Anderson Scott,  Chari Radha

Final Pr. ID: Poster #: SCI-019

Fetal demise (FD) occurs in 1/1000 pregnancies after 20 weeks gestation. MRI is increasingly being used after ultrasound to assess fetal pathology. FD may occur in the interval between ultrasound and MRI, and various organ systems have been described as having changes on fetal MRI. Although ultrasound findings of FD have been well described, criteria for FD on MRI have not. Diffusion MRI evaluates Na⁺/K⁺ channel viability and can be used to evaluate tissue death. Flowing blood produces signal loss on MRI, and along with fetal heart activity results in MRI signal loss of the cardiac chambers. FD with no heart motion and increased signal within non-flowing blood in the heart should result in increased signal in the chambers relative to the myocardium. Either of these findings can be seen with different fetal pathology, but the combination of brain and cardiac changes may allow for a diagnosis of FD. We hypothesize that restricted brain diffusion in certain brain lobes along with increased signal within heart chambers is specific for FD. Read More

Authors:  Bhargava Ravi , Anderson Scott , Chari Radha

Keywords:  Fetal MRI, Brain, Cardiac

Farkas Amy,  Roda Manohar

Final Pr. ID: Poster #: EDU-015

As an inexpensive modality that does not require ionizing radiation, ultrasound is the preferred method for screening for fetal anomalies. When an abnormality is detected on ultrasound, the limitations of the modality often elicit further evaluation with MRI, as MRI can provide more detail and information to the radiologist and clinician. Chest and cardiac pathologies are among the most common findings on prenatal ultrasound and often warrant additional imaging. Consequently, an understanding of these findings and how they appear on different modalities is essential to the pediatric imager.
This electronic exhibit features fetal ultrasound and MRI of mediastinal lymphangioma, type I-III congenital pulmonary airway malformations, intralobar, extralobar, and subdiaphragmatic sequestrations, left and right sided congenital diaphragmatic hernias, hypoplastic left heart, heterotaxy, AV canal defect, and rhabdomyoma. In addition to reviewing the correlation of findings on ultrasound and MRI, prognosis as well as conditions and syndromes commonly associated with these chest and cardiac anomalies will be examined.
The goal of this exhibit is to provide an overview of common fetal cardiopulmonary abnormalities on different, complementary imaging modalities. Familiarity with these conditions is necessary for the radiologist to provide critical information to clinicians to allow prompt intervention in the postnatal period. These findings can additionally serve as an indication to the radiologist to search for associated findings, allowing prognostication and appropriate counseling of parents. Read More

Authors:  Farkas Amy , Roda Manohar

Keywords:  Cardiopulmonary, Fetal MRI

Vidal Lorenna,  Guimaraes Carolina

Final Pr. ID: Poster #: EDU-040

Cerebral aqueductal stenosis remains the most common cause of congenital and acquired obstructive hydrocephalus. The objective of this educational exhibit is to interactively illustrate the imaging findings associated with aqueductal stenosis on Fetal and postnatal MRI. Causes of aqueductal stenosis and imaging protocol optimization will also be discussed.
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Authors:  Vidal Lorenna , Guimaraes Carolina

Keywords:  Aqueductal stenosis, hydrocephalus, fetal MRI

Michishita Yukiko,  Miyazaki Osamu,  Imai Ayako,  Okamato Reiko,  Tsutsumi Yoshiyuki,  Miyasaka Mikiko,  Sago Haruhiko,  Kanamori Yutaka,  Nosaka Shunsuke

Final Pr. ID: Poster #: SCI-004

Esophageal atresia (EA) is a relatively rare congenital anomaly. Esophageal pouch (EP) is the only direct sign of EA on fetal MRI, but is not always seen. Distended hypopharynx (DHP) has been reported as a useful prenatal sign of EA, but as EP and DHP are both subjective assessments, the prenatal diagnosis of EA is challenging. The aim of this study was to evaluate whether quantitative measurement of distended pharynx is useful in the diagnosis of EA. Read More

Authors:  Michishita Yukiko , Miyazaki Osamu , Imai Ayako , Okamato Reiko , Tsutsumi Yoshiyuki , Miyasaka Mikiko , Sago Haruhiko , Kanamori Yutaka , Nosaka Shunsuke

Keywords:  Esophageal Atresia, fetal MRI, Quantitative

Teixeira Sara,  Alves Cesar Augusto,  Martin-saavedra Juan,  Goncalves Fabricio,  Zarnow Deborah,  Feygin Tamara,  Andronikou Savvas

Final Pr. ID: Paper #: 105

Postmortem imaging is increasingly used following stillbirths and neonatal death. Estimating time of death has legal, biological, and ethical implications. This study aims to investigate feasibility of prenatal MRI in estimating time of death in intra-uterine fetal demise (IUFD). Read More

Authors:  Teixeira Sara , Alves Cesar Augusto , Martin-saavedra Juan , Goncalves Fabricio , Zarnow Deborah , Feygin Tamara , Andronikou Savvas

Keywords:  Fetal MRI, Brain, Autopsy

Smith (garcia) Jacquelyn,  Meyers Mariana,  Mirsky David

Final Pr. ID: Poster #: EDU-028

Central nervous system (CNS) infections acquired in-utero are a significant cause of fetal and neonatal morbidity and mortality. Early detection is crucial for timely therapy, prognostication, and peripartum planning. Fetal imaging plays an important role in diagnosing CNS infection and determining the extent of involvement. It has been of particular diagnostic importance with the current outbreak of Zika virus, a neurotropic virus that can result in severe CNS anomalies. An imaging review of commonly encountered congenital infections, including Zika virus, will be presented, with an emphasis on fetal magnetic resonance imaging (MRI). Read More

Authors:  Smith (garcia) Jacquelyn , Meyers Mariana , Mirsky David

Keywords:  Fetal MRI, CNS Infection, Zika Virus

Marin Concha Julio,  Qu Feifei,  Hernandez Andrade Edgar,  Jella Pavan,  Mody Swati,  Subramanian Karthikeyan,  Ghassaban Kiarash,  Romero Roberto,  Haacke E.

Final Pr. ID: Poster #: SCI-006

Magnetic Resonance Imaging is a powerful tool for the detection of ferromagnetic components. This property can be used for the early detection of pathologic conditions related to liver iron overload. Neonatal hemochromatosis and hemosiderosis are conditions associated with severe liver disease. Infections like parvovirus and cytomegalovirus, metabolic conditions and gestational allo-immune liver disease can produce neonatal hemochromatosis phenotype.
Fetal iron overload can be detected early by using T₂* multi-echo gradient sequence.
There are only few studies reporting standard T₂* values of the fetal liver at 1.5 T.
The aim of this study is to evaluated the standard T₂* values of the fetal liver using prenatal MRI with 3.0 T. Read More

Authors:  Marin Concha Julio , Qu Feifei , Hernandez Andrade Edgar , Jella Pavan , Mody Swati , Subramanian Karthikeyan , Ghassaban Kiarash , Romero Roberto , Haacke E.

Keywords:  Fetal MRI, T2* mapping, Neonatal hemochromatosis

Foust Alexandra,  Barnewolt Carol,  Poorvu Tabitha,  Parad Richard,  Estroff Judy

Final Pr. ID: Paper #: 124

To determine the accuracy and significance of a fetal diagnosis of midface hypoplasia. Read More

Authors:  Foust Alexandra , Barnewolt Carol , Poorvu Tabitha , Parad Richard , Estroff Judy

Keywords:  Fetal MRI, Fetal Sonography

Machnitz Judit,  Kazmi Faaiza,  Mallon Mea,  Poletto Erica,  Malik Archana,  Urbine Jaqueline

Final Pr. ID: Poster #: EDU-099

Fetal MR imaging plays a continuously increasing role as an adjunct to routine prenatal ultrasound examinations in confirming and clarifying prenatal abnormalities, usually at an earlier gestational age. It also has a critical role in parental counseling, prenatal and postnatal surgical planning, and delivery method. Our pictorial review demonstrates a variety of common and less typical congenital pathology. Read More

Authors:  Machnitz Judit , Kazmi Faaiza , Mallon Mea , Poletto Erica , Malik Archana , Urbine Jaqueline

Keywords:  Fetal MRI, Postnatal correlation

Snyder Elizabeth,  Baschat Ahmet,  Huisman Thierry,  Tekes-brady Aylin

Final Pr. ID: Poster #: EDU-076

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. Read More

Authors:  Snyder Elizabeth , Baschat Ahmet , Huisman Thierry , Tekes-brady Aylin

Keywords:  fetal MRI, fetal management

Wise Rachel,  Belchos Jessica,  Gray Brian,  Timsina Lava,  Brown Brandon

Final Pr. ID: Poster #: SCI-011

Frequently diagnosed on prenatal imaging, including fetal MRI, omphalocele has highly variable morbidity and mortality. Few prenatal prognostic indicators have been previously identified. We propose that features found on fetal MRI can predict morbidity and mortality in patients diagnosed with omphalocele. Read More

Authors:  Wise Rachel , Belchos Jessica , Gray Brian , Timsina Lava , Brown Brandon

Keywords:  Omphalocele, Fetal MRI, Prognostication

Bauer Matthew,  Burgess Matthew,  Heitzmann Mark

Final Pr. ID: Poster #: EDU-015

This educational exhibit will demonstrate the strengths and weakness of Fetal MRI at 3 Tesla in the evaluation of multiple gestations. Read More

Authors:  Bauer Matthew , Burgess Matthew , Heitzmann Mark

Keywords:  Fetal, MRI

Golden Eleza,  Alazraki Adina,  Milla Sarah,  Desai Nilesh

Final Pr. ID: Poster #: SCI-068

Prior studies have suggested that patients undergoing fetal MRI have a high level of anxiety, while other studies have indicated that patients have a limited understanding of the role of the radiologist in patient care. Further, many patients would prefer to learn their results immediately after the examination rather than wait to meet with their obstetrician. Our objective is to assess patient perception of what fetal MRI is and the role of the radiologist. Read More

Authors:  Golden Eleza , Alazraki Adina , Milla Sarah , Desai Nilesh

Keywords:  fetal MRI, radiologist, consultation

Supakul Nucharin

Final Pr. ID: Poster #: CR-005

To demonstrate an unusual association of VECTERL and uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndromes in fetal MRI with post mortem MRI correlation. Read More

Authors:  Supakul Nucharin

Keywords:  VECTERL, VATER, OHVIRA, Herlyn-Werner-Wunderlich syndrome, Fetal MRI

Saguintaah Magali,  Couture Alain,  Taleb Arrada Ikram,  Bolivar Perrin Julie,  Baud Catherine,  David Stephanie,  Prodhomme Olivier

Final Pr. ID: Poster #: SCI-007

To present a MRI technic to explore the fetal petrous bone (3D high resolution MRI) and choanae, olfactory bulbs and sulci (3D whole brain sequence). To present the clinical applications in fetal detection of CHARGE syndrome. To remind the major diagnostic criteria of CHARGE syndrome. Read More

Authors:  Saguintaah Magali , Couture Alain , Taleb Arrada Ikram , Bolivar Perrin Julie , Baud Catherine , David Stephanie , Prodhomme Olivier

Keywords:  fetal petrous bone, fetal olfactory bulbs, CHARGE syndrome, 3D HR fetal MRI

Farkas Amy,  Roda Manohar

Final Pr. ID: Poster #: EDU-013

Genitourinary abnormalities are frequently detected on prenatal ultrasound, with findings detected on 1 in 500 routine prenatal sonograms. Early detection of abnormalities of the genitourinary system is essential as it allows planning for further work-up and intervention and appropriate counseling of parents. Findings on prenatal ultrasound often trigger further evaluation with fetal MRI, as MRI can provide superior anatomic detail and better assess for associated findings. An understanding of the appearance of genitourinary abnormalities on fetal MRI is important to enable accurate diagnoses and effectively guide clinicians in patient management.
This educational poster highlights fetal MRI cases that demonstrate genitourinary abnormalities including bilateral renal agenesis with Potter sequence, crossed fused renal ectopia, multicystic dysplastic kidney, duplex collecting system, posterior urethral valves, patent urachus, allantoic cyst, prune belly syndrome, congenital megaureter, cloaca, bladder exstrophy, ureteropelvic junction obstruction, horseshoe kidney, and sirenomelia.
The goal of this exhibit is to provide familiarity with these findings and their clinical implications, which is particularly important for those with less fetal MRI experience. In addition, the exhibit will provide an overview of the embryology of the genitourinary system as it relates to the abnormalities to provide further context of the pathophysiology of these complex congenital conditions. Read More

Authors:  Farkas Amy , Roda Manohar

Keywords:  Genitourinary, Fetal MRI

Elliott Lauren,  Alazraki Adina,  Milla Sarah

Final Pr. ID: Poster #: EDU-010 (R)

Fetal MRI is a unique method which allows clinicians to diagnose or exclude abnormalities during pregnancy. MR images are acquired when details from an ultrasound may not be sufficient to make a complete prenatal diagnosis or when there are concerns for additional findings. This method of imaging is optimal due to the diagnostic quality of the images and the absence of ionizing radiation. We present an educational exhibit to discuss the methodology in performing a fetal MRI as well as demonstrating common findings in fetal MRI. Read More

Authors:  Elliott Lauren , Alazraki Adina , Milla Sarah

Keywords:  Fetal, MRI, Technologist

Goncalves Luis,  Patel Mittun,  Wermers Josh,  Simmons Curtis,  Vaughn Jennifer,  Pfeifer Cory,  Cornejo Patricia

Final Pr. ID: Poster #: CR-003

Kagami-Ogata syndrome (KOS) is a rare and potentially underdiagnosed imprinting disorder caused by paternal uniparental disomy for chromosome 14 or microdeletions and epimutations involving differentially methylated regions (DMRs) at 14q32.2. Depending on phenotypic expression, KOS may mimic trisomy 18 and asphyxiating thoracic dysplasia. Therefore, awareness is essential for prenatal diagnosis. Coat hanger ribs as seen by x-rays have been reported as s pathognomonic sign but have not been reported prenatally. Herein we present images of the coat hanger ribs as seen by low-dose computerized tomography (CT) as well as detailed imaging of the multiple phenotypic features by ultrasound and MRI of KOS in two cases seen prenatally. Case 1: G1P0 singleton pregnancy had fetal echocardiogram at 25 weeks due to concern for congenital heart disease, thickened nuchal fold and thickened skin of the thoracic wall. The exam showed left superior vena cava draining to coronary sinus, dilated right atrium and right ventricle, total anomalous pulmonary venous return, and hydrops. Skin edema was redemonstrated by follow up US at 29 weeks. Fetal MRI and follow-up US at 32 weeks showed polyhydramnios, diffuse skin edema, prominent cheeks and frontal bossing by 3D US, mild shortening of the ulna and right clubfoot, and a bell-shaped thorax by MRI. Chromosomal microarray was positive for terminal deletion of 14q32.2, consistent with KOS. Coat hanger ribs were present on postnatal x-rays. The patient is G-tube and tracheostomy tube dependent, has global developmental delay, neuromuscular scoliosis, left hip subluxation, wrist contractures and planovalgus feet at the age of 2 ½ years. Case 2: G3P1, singleton pregnancy with negative non-invasive prenatal testing (NIPT). US performed at 29 weeks showed polyhydramnios, clenched hands, and bell-shaped small thorax. Multimodality fetal imagin (US, MRI and CT) at 32 weeks showed a narrowed elongated thorax by US and MRI but ribs were poorly visualized. Additional anomalies included polyhydramnios, rhizomelic bone shortening, clenched hands, and prominent cheeks by 3D US. Low-dose CT showed coat hanger ribs. Postnatal x-rays confirmed coat hanger ribs and other abnormalities. Postnatal genetic testing showed paternal uniparental disomy for chromosome 14, consistent with KOS. The patient has restrictive lung disease due to hypoplastic thoracic cage, hypotonia, scoliosis, developmental delay, and umbilical hernia at 13 months. Read More

Authors:  Goncalves Luis , Patel Mittun , Wermers Josh , Simmons Curtis , Vaughn Jennifer , Pfeifer Cory , Cornejo Patricia

Keywords:  kagami-ogata, fetal MRI, fetal CT

Fagen Kimberly,  Blask Anna,  Rubio Eva,  Loomis Judyta,  Bulas Dorothy

Final Pr. ID: Poster #: SCI-008

To assess if malrotation of the bowel can be detected on prenatal MRI. Read More

Authors:  Fagen Kimberly , Blask Anna , Rubio Eva , Loomis Judyta , Bulas Dorothy

Keywords:  Malrotation, Heterotaxy, Fetal MRI

Lazarte Claudia,  Montero José,  Mejia Richard,  Huamani Jesus,  Ugas-charcape Carlos

Final Pr. ID: Paper #: 006 (S)

Determinar los diámetros promedio de la laringe y la tráquea fetal por resonancia magnética.

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Authors:  Lazarte Claudia , Montero José , Mejia Richard , Huamani Jesus , Ugas-charcape Carlos

Keywords:  Fetal MRI, Dilatación, tráquea y laringe

Pfeifer Cory,  Beavers Angela

Final Pr. ID: Poster #: CR-002

Teratomas uncommonly manifest in the gastrointestinal system, and most international literature cites the total number of gastric teratomas reported to be approximately 120. Of these, only 12-30 are of the immature variety. Reports of immature gastric teratoma in the United States are scant. Presented here are images from what appears to be the first known fetal MRI to demonstrate a gastric immature teratoma with follow-up radiographic, fluoroscopic, and CT imaging of the infant. Read More

Authors:  Pfeifer Cory , Beavers Angela

Keywords:  Fetal MRI, Gastric Teratoma

Soun Jennifer,  Ayyala Rama,  Maddocks Alexis,  Miller Russell,  Simpson Lynn,  Laifer-narin Sherelle

Final Pr. ID: Poster #: SCI-048

Monochorionic multiple gestations are at risk for complications related to a shared placenta. In utero therapies such as fetoscopic laser and radiofrequency ablation (RFA) are used to treat these complications. Previous work at our institution demonstrated a low rate of neuroanatomical abnormalities on post-therapy fetal imaging. The purpose of this study was to evaluate postnatal neurological outcomes within the same cohort.
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Authors:  Soun Jennifer , Ayyala Rama , Maddocks Alexis , Miller Russell , Simpson Lynn , Laifer-narin Sherelle

Keywords:  Fetal, MRI, Brain

Leake David

Final Pr. ID: Poster #: CR-067

The purpose of this case report is to describe a rare case of epignathus (oral teratoma) with lateral skull base and intracranial extension. A 29-year-old G4P1122 female was referred to our institutuion after third trimester ultrasound and fetal MRI revealed a 34 week fetus with oral mass. There was extension intracranially through the lateral skull base. The complex mass showed cystic, solid, and fatty components. Polyhydramnios was also demonstrated. The prenatal imaging was crucial in planning the delivery of the fetus using EXIT procedure. Postnatal MRI Head and Neck, CT Head and Neck, CTA Head and Neck were helpful in guiding surgical resection of the oral, skull base, and intracranial mass. Emphasis will be made on the value of imaging to guide the management of this extremely difficult and rare case. Read More

Authors:  Leake David

Keywords:  epignathus, teratoma, Fetal MRI, Skull Base

Goncalves Luís,  Jain Shilpa,  Krishnan Ananth,  Yuxiang Zhou,  Bloom David,  Lee Wesley,  Romero Roberto

Final Pr. ID: Poster #: SCI-079

To develop reference ranges for cerebellum and posterior fossa measurements by fetal MRI and to investigate the reproducibility and diagnostic performance of quantitative MR parameters for the differentiation of fetal posterior fossa abnormalities. Read More

Authors:  Goncalves Luís , Jain Shilpa , Krishnan Ananth , Yuxiang Zhou , Bloom David , Lee Wesley , Romero Roberto

Keywords:  posterior fossa, cerebellar vermis, Blake's pouch cyst, fetal MRI, Dandy-Walker malformation

Alford Raphael,  Rubesova Erika,  Halabi Safwan,  Blumenfeld Yair,  Hintz Susan,  Barth Richard

Final Pr. ID: Poster #: SCI-049

The purpose of this study is to determine the reliability of sonographic (US) lung measurements compared with Fetal MR in fetuses with congenital diaphragmatic hernia. The sonographic lung head ratio (LHR) is a widely used prognostic tool in CDH, but can be difficult to obtain due to shifted mediastinum and fetal position. To our knowledge, comparison of MRI measured LHR with US has not been previously reported. Read More

Authors:  Alford Raphael , Rubesova Erika , Halabi Safwan , Blumenfeld Yair , Hintz Susan , Barth Richard

Keywords:  Congenital diaphragmatic hernia, Lung head ratio, LHR, Fetal MRI, Lung volumes

Willard Scott,  Birkemeier Krista

Final Pr. ID: Poster #: CR-034

Prenatal screening ultrasound at 18 weeks gestation identified homogeneous enlargement of the distal left leg. There was relative increased blood flow by Doppler, but the bone lengths were symmetric. There were no cysts and no amniotic bands. MRI was performed at 21 weeks gestation for further characterization. MRI demonstrated a lobulated, infiltrative, asymmetric soft tissue signal intensity thickening extending from the knee to the dorsum of the foot. There was no fat content appreciable on T1 or T2 fat saturated images. Given these findings, a vascular soft tissue mass such as kaposiform hemangioendothelioma was the primary differential consideration, with other fibrous tumors considered less likely. Follow up ultrasounds demonstrated commensurate growth of the lesion with the child.

At scheduled cesarean delivery, the otherwise healthy female infant had a leg mass that measured 14 cm, extending from the knee to the dorsum of the foot, as seen on prenatal imaging. The skin overlying the lesion was thick and redundant with hypertrichosis. Postnatal MRI was performed on day 2, unexpectedly showing extensive fat signal, along with edema signal and enhancement of the muscle, fat, and thickened skin. There was no abnormal vascularity and no focal mass. There was mild tibial bowing. Incisional biopsy was performed on day 6, with pathologic diagnosis of spindle cell tumor suggestive of fibrous hamartoma of infancy (FHI).

This apparent case of FHI is an atypical presentation, with interesting imaging implications. FHI is usually smaller (3-5 cm), more common in males (2.4:1), and only rarely involves the lower extremities distal to the knee (0.5% of cases). Only 23% of FHI are present at birth. To our knowledge, there are no case reports describing the fetal MRI appearance of this entity. Hamartomatous lesions and macrodystrophia lipomatosa had been excluded from the differential diagnosis due to the lack of fat signal intensity on fetal MRI. However, the fetus was imaged in early second trimester and normal subcutaneous fat is usually not visible on MRI until late in the second trimester. This case raises questions regarding the timing of appearance of fat in this lesion. As a result, we recommend that fat containing lesions not be excluded on the basis of absence of fat in early fetal MRI. Repeat MR imaging of musculoskeletal tumors in the third trimester to re-assess content may be useful. Read More

Authors:  Willard Scott , Birkemeier Krista

Keywords:  FHI, Fibrous hamartoma of infancy, kaposiform hemangioendothelioma, fetal MRI