Showing 9 Abstracts.
Various types of cystic structures are present in the fetal abdomen. Preliminary evaluation of cystic lesions utilizes ultrasound. Given the wide range of manifestations of cysts in the fetal abdomen including but not limited to mesenteric, duplication, choledochal, ovarian, to lymphatic malformations proper diagnosis can prove difficult. When ultrasound yields inconclusive results, the next step is further investigation with fetal MRI. Fetal MRI provides increased resolution to fully characterize an abdominal cyst. Proper identification of a cyst provides useful guidance for appropriate perinatal management. Clinical management of fetal cysts consists of watchful watching, serial ultrasounds after birth, to surgical intervention. Recognition of the various types of cysts by a radiologist can help allow a clinician to appropriately counsel families about the next steps in the medical care of their child. This presentation highlights the spectrum cystic lesions seen on MRI in the fetal abdomen. We outline a systemic method for identification of fetal abdominal cysts. Various examples of abdominal cysts will be reviewed focusing on key differences which can narrow the differential diagnosis and allow for proper identification. Results from fetal MRI will be correlated with an ultrasound shortly after birth to ensure appropriate diagnosis. Read More
Meeting name: SPR 2020 Annual Meeting & Postgraduate Course , 2020
Authors: Sostarich Cortney, Brown Brandon
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
Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019
Authors: Vansyckel Arielle, Brown Brandon
Keywords: Fetal imaging, Midface anomaly
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. Read More
Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018
Authors: Cassella Katharyn, Brown Brandon
Keywords: Omphalocele, Ventral hernia, Abdominoscisis
MRI evaluation of the placenta, and particularly placental vascularity, is a critical yet challenging task for the radiologist. Failure to accurately diagnose ischemic changes or to detect signs of the abnormally invasive placenta can have devastating consequences for both maternal and fetal patients. The radiologist's task is further complicated by the inability to use intravenous contrast. In this presentation, we outline a 7-point, systematic method for evaluation of the placenta, highlighting key changes in appearance and signal intensity between 1.5T and 3T MR field strength, and also incorporating a novel method for evaluating blood flow within placental parenchyma utilizing a hybrid image derived from (noncontrast) SSFP and SSFSE pulse sequences. Our systematic approach analyzes the following diagnostic criteria: location, presence of deep vessels, presence of enlarged/ectatic vessels, presence of fibrin/blood products, disruption of uterine myometrial signal, focal bulge, and signal irregularity of the bladder dome. Finally, we correlate this diagnostic method with a quantitative scoring system which can further aid with delivery planning and prognostication. Read More
Meeting name: SPR 2017 Annual Meeting & Categorical Course , 2017
Authors: Brown Brandon, Shea Lindsey, Marine Megan
Keywords: MRI, placenta, vasculature
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. Read More
Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019
Authors: Steinhardt Nicole, Meyers Mariana, Brown Brandon
Genitourinary abnormalities are frequently detected on prenatal imaging. Though many anomalies are easily diagnosed on ultrasound and MR imaging, those that lead to hydrocolpos are not always as easy to distinguish. The purpose of this educational poster is to review the causes of prenatal hydrocolpos and provide an organized approach to differentiate these entities on prenatal imaging. Several examples of ultrasound and fetal MR imaging are provided to illustrate multiple abnormalities that can produce hydrocolpos (e.g., cloacal malformations, persistent urogenital sinus, congenital adrenal hyperplasia, transverse vaginal septum, imperforate hymen, vaginal atresia) and to distinguish other lesions that may mimic hydrocolpos (e.g., sacrococcygeal teratoma, ovarian cyst). A diagnostic approach is provided for differentiating the various causes of hydrocolpos on prenatal imaging. When available, postnatal imaging, physical examination, and endoscopic correlations are provided for diagnostic confirmation or clarification. Complications and associated abnormalities are discussed to provide additional considerations for prenatal evaluation and treatment planning. At the end of this module, viewers will better understand and differentiate the various entities that lead to hydrocolpos on prenatal imaging. Read More
Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023
Authors: Newman Christopher, Forbes-amrhein Monica, Brown Brandon, Marine Megan
Keywords: Hydrocolpos, Cloaca, Urogenital Sinus
Radiographic findings of right diaphragmatic eventration may overlap with true hernia if only liver herniates without bowel. We thus wanted to know the accuracy of ultrasonography (US) in the diagnosis of right diaphragmatic hernia. Read More
Meeting name: SPR 2018 Annual Meeting & Postgraduate Course , 2018
Authors: Schold Andrew, Marine Megan, Brown Brandon, Gray Brian, Karmazyn Boaz
Keywords: Diaphragm, Hernia, Ultrasound
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
Meeting name: SPR 2019 Annual Meeting & Postgraduate Course , 2019
Authors: Wise Rachel, Belchos Jessica, Gray Brian, Timsina Lava, Brown Brandon
Keywords: Omphalocele, Fetal MRI, Prognostication
Bronchopulmonary sequestration (BPS) is a rare congenital abnormality of the lower airway resulting in a mass of nonfunctional lung tissue. Our purpose is to present the prenatal and postnatal imaging findings of a spectrum of BPS cases and to correlate with pathology findings. We present a series of BPS evaluated with prenatal imaging (US and MRI) and postnatal imaging (radiographs, US, CT, and MRI). Pathology will be reviewed. Our series includes isolated BPS, hybrid BPS associated with cystic pulmonary airway malformation (CPAM), BPS associated with diaphragmatic hernia, and challenging cases of intradiaphragmatic, subdiaphragmatic, and mediastinal sequestrations that can mimic other masses. We also include a case of sequestration with an associated communication to the GI tract (bronchopulmonary foregut malformation) and a case of isolated BPS that spontaneously involutes over time. Read More
Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023
Authors: Chilukuri Sanjeev, Karmazyn Boaz, Wanner Matthew, Brown Brandon, Gray Brian, Marine Megan
Keywords: Sequestration, Fetal, Bronchopulmonary