Fast MR imaging of fetal CNS anomalies in utero.

BACKGROUND AND PURPOSE Although sonography is the primary imaging technique for evaluating the developing fetus, significant limitations exist in the sonographic prenatal diagnosis of many brain disorders. Fast MR imaging is increasingly being used to determine the underlying cause of nonspecific fetal CNS abnormalities detected sonographically and to confirm or provide further support for such anomalies. Our goal was to determine the value of MR imaging in establishing the diagnosis of fetal CNS anomalies, to ascertain how this information might be used for patient counseling, and to assess its impact on pregnancy management. METHODS We prospectively performed MR examinations of 73 fetuses (66 pregnancies) with suspected CNS abnormalities and compared these with available fetal sonograms, postnatal images, and clinical examinations. Retrospectively, the impact on patient counseling and pregnancy management was analyzed. RESULTS Images of diagnostic quality were routinely obtained with in utero MR imaging, which was particularly valuable in detecting heterotopia, callosal anomalies, and posterior fossa malformations, and for providing excellent anatomic information. We believe that 24 (46%) of 52 clinical cases were managed differently from the way they would have been on the basis of sonographic findings alone. In every case, the referring physicians thought that MR imaging provided a measure of confidence that was not previously available and that was valuable for counseling patients and for making more informed decisions. CONCLUSION Sonography is the leading technique for fetal assessment and provides reliable, inexpensive diagnostic images. Fast MR imaging is an important adjunctive tool for prenatal imaging in those instances in which a complex anomaly is suspected by sonography, when fetal surgery is contemplated, or when a definitive diagnosis cannot be determined.

[1]  A. Barkovich,et al.  Antenatal diagnosis of subependymal heterotopia. , 2000, AJNR. American journal of neuroradiology.

[2]  H. Hricak,et al.  Complex fetal disorders: effect of MR imaging on management--preliminary clinical experience. , 1999, Radiology.

[3]  R. Edelman,et al.  Obstetric MR imaging. , 1999, Radiology.

[4]  C. Garvan,et al.  Cranial Ultrasound Abnormalities Identified at Birth: Their Relationship to Perinatal Risk and Neurobehavioral Outcome , 1999, Pediatrics.

[5]  M. Hansmann,et al.  Endoscopic laser surgery versus serial amniocenteses in the treatment of severe twin-twin transfusion syndrome. , 1999, American journal of obstetrics and gynecology.

[6]  R. Edelman,et al.  Fetal CNS anomalies revealed on ultrafast MR imaging. , 1999, AJR. American journal of roentgenology.

[7]  D. Levine,et al.  Cortical maturation in normal and abnormal fetuses as assessed with prenatal MR imaging. , 1999, Radiology.

[8]  T. de Ravel,et al.  Hydrolethalus syndrome in a non‐Finnish family: confirmation of the entity and early prenatal diagnosis , 1999, Prenatal diagnosis.

[9]  J. Bowie,et al.  Sonographic evaluation of fetal CNS: technical and interpretive pitfalls. , 1999, AJR. American journal of roentgenology.

[10]  M. Hernanz-Schulman,et al.  Reduced Hindbrain Herniation after Intrauterine Myelomeningocele Repair: A Report of Four Cases , 1998, Pediatric Neurosurgery.

[11]  G. Buonocore,et al.  Inflammatory Pathogenesis of Cortical Polymicrogyria: An Autopsy Study 1 , 1998, Pediatric Research.

[12]  N. Tulipan,et al.  Myelomeningocele Repair in utero: A Report of Three Cases , 1998, Pediatric Neurosurgery.

[13]  G. Sebag,et al.  Magnetic resonance imaging of the fetus , 1998, Pediatric Radiology.

[14]  N. Burdi,et al.  Magnetic resonance imaging of normal and pathologic fetal brain , 1998, Child's Nervous System.

[15]  P. Sonigo,et al.  MR imaging of fetal cerebral anomalies , 1998, Pediatric Radiology.

[16]  R R Edelman,et al.  Fetal fast MR imaging: reproducibility, technical quality, and conspicuity of anatomy. , 1998, Radiology.

[17]  J. Bowie,et al.  Fetal cerebral ventriculomegaly: misidentification of the true medial boundary of the ventricle at US. , 1997, Radiology.

[18]  Wei Li,et al.  Fetal central nervous system anomalies: MR imaging augments sonographic diagnosis. , 1997, Radiology.

[19]  D. Twickler,et al.  The Developmental Outcome of Children With Antenatal Mild Isolated Ventriculomegaly , 1997, Obstetrics and gynecology.

[20]  G. Mychaliska,et al.  Operating on placental support: the ex utero intrapartum treatment procedure. , 1997, Journal of pediatric surgery.

[21]  M Takahashi,et al.  MR imaging of the fetus by a HASTE sequence. , 1997, AJR. American journal of roentgenology.

[22]  P. Colletti Computer-assisted imaging of the fetus with magnetic resonance imaging. , 1996, Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society.

[23]  R R Edelman,et al.  Fetal anatomy revealed with fast MR sequences. , 1996, AJR. American journal of roentgenology.

[24]  W. Ellis,et al.  A magnetic resonance template for normal neuronal migration in the fetus. , 1996, Neurosurgery.

[25]  C. Garel,et al.  [Magnetic resonance imaging of the fetus. Contribution to antenatal diagnosis]. , 1996, Presse medicale.

[26]  R. Goldstein,et al.  Sonographic anatomy of the developing cerebellum: normal embryology can resemble pathology. , 1996, AJR. American journal of roentgenology.

[27]  R. Fitzgerald,et al.  The Dandy-Walker syndrome--a 10-year experience of its management and outcome. , 1995, European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie.

[28]  R. Lilford,et al.  Assessment and management of fetal agenesis of the corpus callosum , 1995, Prenatal diagnosis.

[29]  A J Barkovich,et al.  Correlation of prenatal events with the development of polymicrogyria. , 1995, AJNR. American journal of neuroradiology.

[30]  N. Girard,et al.  In vivo MR study of brain maturation in normal fetuses. , 1995, AJNR. American journal of neuroradiology.

[31]  S. Pauker,et al.  Closure of the cerebellar vermis: evaluation with second trimester US. , 1994, Radiology.

[32]  R. Lilford,et al.  Management of apparently isolated fetal ventriculomegaly. , 1994, Obstetrical & gynecological survey.

[33]  W. Löscher,et al.  Effects of static and time-varying (50-Hz) magnetic fields on reproduction and fetal development in rats. , 1994, Teratology.

[34]  R. Goldstein,et al.  Isolated mild fetal cerebral ventriculomegaly: clinical course and outcome. , 1994, Radiology.

[35]  P. Doubilet,et al.  Sonography of the fetal posterior fossa: false appearance of mega-cisterna magna and Dandy-Walker variant. , 1994, Radiology.

[36]  R. Frydman,et al.  Magnetic resonance imaging of the fetus: A study of 20 cases performed without curarization , 1993, Prenatal diagnosis.

[37]  N. Girard,et al.  Prenatal diagnosis of fetal cerebral abnormalities by ultrasonography and magnetic resonance imaging. , 1993, European journal of obstetrics, gynecology, and reproductive biology.

[38]  F. Shellock,et al.  Survey of reproductive health among female MR workers. , 1993, Radiology.

[39]  A. Achiron,et al.  Fetal Mild Idiopathic Lateral Ventriculomegaly: is There a Correlation with Fetal Trisomy? , 1993, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[40]  N. Girard,et al.  In vivo MRI of fetal brain cellular migration. , 1992, Journal of computer assisted tomography.

[41]  A. Garden,et al.  Fast‐scan magnetic resonance imaging of fetal anomalies , 1991, British journal of obstetrics and gynaecology.

[42]  R. Griffiths,et al.  Fast-scan magnetic resonance imaging in fetal visualization. , 1991, American journal of obstetrics and gynecology.

[43]  B. Bromley,et al.  Mild fetal lateral cerebral ventriculomegaly: clinical course and outcome. , 1991, American journal of obstetrics and gynecology.

[44]  K. Sulik,et al.  Effects of magnetic resonance imaging on eye development in the C57BL/6J mouse. , 1991, Teratology.

[45]  T. Hata,et al.  Magnetic resonance imaging of the fetus: initial experience. , 1991, Gynecologic and obstetric investigation.

[46]  C. Truwit,et al.  Brain damage from perinatal asphyxia: correlation of MR findings with gestational age. , 1990, AJNR. American journal of neuroradiology.

[47]  G J Beers,et al.  Biological effects of weak electromagnetic fields from 0 Hz to 200 MHz: a survey of the literature with special emphasis on possible magnetic resonance effects. , 1989, Magnetic resonance imaging.

[48]  B. Worthington,et al.  Magnetic resonance imaging (MRI) in obstetrics. I. Maternal anatomy , 1988, British journal of obstetrics and gynaecology.

[49]  B S Worthington,et al.  Magnetic resonance imaging (MRI) in obstetrics. II. Fetal anatomy , 1988, British journal of obstetrics and gynaecology.

[50]  H. Hricak,et al.  Magnetic resonance imaging of fetal anomalies in utero: early experience. , 1985, AJR. American journal of roentgenology.

[51]  L. Crooks,et al.  Tests for DNA and chromosomal damage induced by nuclear magnetic resonance imaging. , 1980, Radiology.

[52]  A. Hubbard,et al.  Prenatal magnetic resonance imaging of fetal anomalies. , 1999, Seminars in roentgenology.

[53]  L. Bilaniuk Magnetic resonance imaging of the fetal brain. , 1999, Seminars in roentgenology.

[54]  K. Partanen,et al.  MRI in obstetrics: a supplementary method for ultrasonography. , 1996, Annals of medicine.

[55]  A. Schleicher,et al.  The ontogeny of human gyrification. , 1995, Cerebral cortex.

[56]  P. Mansfield,et al.  A three-year follow-up of children imaged in utero with echo-planar magnetic resonance. , 1994, American journal of obstetrics and gynecology.

[57]  L. Crooks,et al.  NMR imaging produces no observable mutations or cytotoxicity in mammalian cells , 1984 .