SEARCH

SEARCH BY CITATION

Abstract

  1. Top of page
  2. Abstract
  3. Oral presentations
  4. Posters
  5. Morphometry of the posterior fossa and fractional anisotropy of the brainstem: parameters aiding in the differentiation between open and closed neural tube defects

Abstracts of the Fourth International Congress and Fifth International Course on Fetal MRI, held at the Imperial Riding School Renaissance Vienna Hotel, Vienna, Austria on 4–8 June 2013 (http://www.mcaevents.org/t/01/ultrasound-meets-magnetic-resonance/index.aspx).


Oral presentations

  1. Top of page
  2. Abstract
  3. Oral presentations
  4. Posters
  5. Morphometry of the posterior fossa and fractional anisotropy of the brainstem: parameters aiding in the differentiation between open and closed neural tube defects

Diagnostic problems in case of twin pregnancies – MRI study

M. Bekiesinska-Figatowska1, A. Duczkowska1, I. Herman-Sucharska2, A. Romaniuk-Doroszewska1, R. Jaczynska3, M. Furmanek4, H. Bragoszewska1, A. Dubis2

1Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland, 2Department of Electroradiology, Collegium Medicum, Jagiellonian University, Krakow, Poland, 3Clinic of Obstetrics and Gynecology, Institute of Mother and Child, Warsaw, Poland, 4Department of Radiology, Medical Centre for Postgraduate Education, Warsaw, Poland

Objective

To present own experience with twin pregnancies underlining impact of MRI on diagnosis and management.

Methods

We studied 17 twin pregnancies: 9 monochorionic (4 diamniotic, 5 monoamniotic—conjoined twins), 8 dichorionic. MR examinations were performed at 19–39 gestational weeks in two centers, using 1.5 T scanners. SSFSE/ T2-weighted images were main diagnostic tool supported by TSE or GRE/T1-weighted images, diffusion-weighted imaging (DWI), steady-state free precession (FIESTA) and echoplanar GRE imaging (EPIGRE).

Results

In 11 cases (64.7%) MRI was superior to US and supplied additional information, including 2 cases in which pathology of second twin suspected on US was ruled out on MRI. In 80-90% of twin pregnancies only one fetus has malformations. In our group of 12 cases (excluding the conjoined twins) there were 3 cases (25%) of both twins' abnormalities detected on MRI. Among 5 pairs of conjoined twins MRI was the most helpful in craniopagus case excluding cephalopagus. Twins were successfully separated. In another case MRI showed more details of unusual conjoined twins' anatomy providing evidence of dystrophic upper and lower extremities of second, dystrophic twin, which were not detected on US and twins were considered as having common shoulder and pelvic girdle. In 6 cases (35.3%) MRI confirmed US diagnosis and brought no new data having only an informative role for parents and surgeons.

Conclusions

MRI offers ability of more detailed assessment of fetal pathology in cases of twin pregnancies, including conjoined twins, in which sonographic evaluation is more difficult than in singleton ones.

Outcome of infants with prenatal diagnosis of CAKUT on fetal ultrasound and MRI

D. Csaicsich1, P. C. Brugger2, G. Kasprian3, E. Schönbauer3, D. Bettelheim4, J. Deutinger4, D. Prayer3

1Department of Pediatric Nephrology and Gastroenterology, Medical University of Vienna, Vienna, Austria, 2Center for Anatomy and Cell Biology, Department of Systematic Anatomy, Integrative Morphology Group, Medical University of Vienna, Vienna, Austria, 3Department of Radiology, Medical University of Vienna, Vienna, Austria, 4Department of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Vienna, Austria

Congenital anomalies of the kidney and urinary tract (CAKUT) are estimated to have an incidence of about 0.5–1% in neonates. Therefore CAKUT belong to the most common congenital anomalies. Usually CAKUT can easily be detected on prenatal ultrasound, and there is no debate about its role as the primary screening method for this indication. But fetal magnetic resonance imaging (MRI) may offer some advantages in this group of anomalies, especially in cases with renal oligohydramnios or complex malformations. We present data about fetuses in whom CAKUT was detected on prenatal US and who also had fetal MRI. We compared prenatal diagnosis with the final diagnosis, made by postnatal investigations or postmortem autopsy. We also report about the short and long term outcome in respect to survival and renal function.

Impact of prenatal combined imaging by ultrasound and magnetic resonance on diagnosis of fetal GIT anomalies

V. Frisova1,2, L. Kavalcova3, L. Hornofova4, I. Spalova5, L. Haakova6, D. Smetanova7, M. Rocek2

1Profema - Fetal Medicine Centre Ltd, Prague, Czech Republic, 22nd Faculty of Medicine, Charles University and University Hospital Motol, Department of Radiology, Prague, Czech Republic, 32nd Faculty of Medicine, Charles University and University Hospital Motol, Clinic of Paediatric Surgery, Prague, Czech Republic, 42nd Faculty of Medicine, Charles University and University Hospital Motol, Institute for Pathological Anatomy and Molecular Medicine, Prague, Czech Republic, 52nd Faculty of Medicine, Charles University and University Hospital Motol, Department of Gynaecology and Obstetrics, Prague, Czech Republic, 6Institute for the Care of Mother and Child, Fetal Medicine Unit, Prague, Czech Republic, 7GENNET, Fetal Medicine Unit, Prague, Czech Republic

Objectives

1. To evaluate the impact of combined imaging by ultrasound and MRI on prenatal diagnosis of fetal GIT anomalies. 2. To compare the effectiveness of ultrasound and MRI in diagnosis of fetal GIT anomalies, if performed on the same day by a single specialized operator.

Methods

30 pregnancies with suspected or diagnosed fetal GIT anomaly were included. Ultrasound and MR imaging were performed on the same day by a single operator specialized in fetal medicine. MRI diagnosis was confirmed by a paediatric radiologist. Only cases with known outcomes were included into the analysis.

Results

Postnatal confirmation was available in 19 cases (63%). 18 (95%) were born alive and 1 died neonatally. There were 5 (26%) healthy neonates, 9 (48%) neonates with single isolated GIT anomaly and 5 (26%) with multiple-systems anomalies (1 chromosomal abnormality). There was 84% agreement between postnatal and our combined diagnosis and 74% agreement between referral and postnatal diagnosis. Our examination provided additional information in 58% of pregnancies with agreement between main referral and postnatal diagnosis. This information was clinically relevant in 53% cases.

Conclusions

We have found marked advantage of combined imaging in a specialized centre over prior referral ultrasound examination. In cases with suspect bowel atresia, MRI helped to decide about the presence or absence of this anomaly and estimation of its location. Ultrasound examination was on other hand useful for diagnosis of associated other systems anomalies. This study shows that combined imaging by ultrasound and MRI increases accuracy of prenatal diagnosis thus contributes to the optimization of perinatal management.

Spectrum of fetal mid and hindbrain malformations seen on MRI: review of 13 years of experience at a single institution

S. Kumbla, M. Fink

Medical Imaging Department, The Royal Children's Hospital, Melbourne, Australia

Objective

Malformations of the brainstem and cerebellum are increasingly recognised due to advances in imaging, molecular biology and genetics. Knowledge of the imaging features of these malformations is crucial for patient management. We performed a retrospective review of the spectrum of posterior fossa abnormalities observed in fetuses imaged by MRI at our institution.

Methods

All fetuses with disorders of midbrain and hindbrain recognized on MRI between Jan 2000 to December 2012 were identified using a departmental data base. The images were retrospectively reviewed to document the range of malformations and associated anomalies.

Results

We identified 64 cases. These include 19 (30%) cases of DW related disorders, 15 (23%) cases of patterning defects (short pons, rhombencephalosynapsis, brainstem disconnection syndrome), 15 (23%) cases of cerebellar abnormality (hypoplasia and dysplasia), 6 (9%) cases of Chiari 2 malformations, 6 (9%) cases of encephalocele/meningocele, 2 (3%) cases of other brainstem malformations (pontine tegmental cap dysplasia and z shaped brain stem). Some fetuses had multiple anomalies.

Conclusion

Developmental disorders of the midbrain and hindbrain are often associated with malformations of other organ systems. Our review of these anomalies in fetuses shows that with attention to detail this spectrum of disorders can be identified in the fetus. In our experience the most common malformations include ‘DW related disorders’ and ‘patterning defects’.

Ultrasound MRI fusion: combined registration and visualization in fetal studies

A. Lee, S. Sinnott, R. Sekar, V. Andrjic

Royal Brisbane Womens Hospital, Australia

MRI has become a major image modality in various areas of fetal imaging. Most importantly diagnosis of the CNS has gained accuracy via the addition of MRI. However, ultrasound is the traditional first line modality in the process of evaluation. Operator expertise is readily available in most tertiary centers.

Fusion of different imaging modalities has been successfully applied in various areas of medical imaging, eg. stereotactic interventions, brain cancer staging, radiotherapy treatment. A fusion of modalities in fetal imaging could be helpful in the process of better identification of lesions, learning and documentation. It might further assist in raising expertise in the still limited application of fetal MRI.

We present our preliminary results on a new experimental approach. 3D ultrasound and MRI dataset are used to produce a merged view in various region of interest. Technical aspects as well as clinical benefits and limitations will be evaluated in examples. The algorithm is semiautomatic and requires manual intervention. Software is custom designed and peruses public domain packages.

Fusion of fetal MRI and 3D ultrasound is achievable and may help in selected cases of compromised pregnancies. Standardization of data storage is paramount when combining different modalities.

Susceptibility weighted imaging of the fetal brain is superior to ultrasound and conventional MRI sequences in detecting intracranial hemorrhage

S. Mody1, L. Yeo2,3, J. Neelavalli4, M. Thomason2,5,6, E. Hernandez-Andrade2,3, S. Hassan2,3, R. Romero2, E.M. Haacke4

1Department of Radiology, Wayne State University School, Detroit, Michigan, USA, 3L-8 Detroit Receiving Hospital, 2Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit, Michigan, USA, 3Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA, Perinatology Research Branch, NICHD, NIH, DHHS, Hutzel Women's Hospital, 4Department of Radiology and Biomedical Engineering, Wayne State University, Detroit, Michigan, USA, MR Research Facility, 3990 John R Road, Detroit, MI, USA, 5Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, MI, USA, 6Department of Pediatrics, Wayne State University, Detroit, MI, USA

Background

Susceptibility weighted imaging (SWI) is a high resolution 3D gradient echo sequence that utilizes magnitude and filtered-phase with post processing to accentuate the paramagnetic properties of blood products. SWI is highly sensitive in the detection of intravascular venous deoxygenated blood, as well as extravascular blood products. This sequence also detects iron and calcifications, and SWI filtered phase is used to differentiate between hemorrhage and lesions with calcifications. SWI has gained importance in advanced adult and pediatric neuroimaging. Here we report the modification of SWI sequences and its utility to image fetal brain pathology.

Case series

Fetuses with abnormal sonographic findings of the fetal brain on 2D ultrasound (US) underwent MRI. Two fetuses had ventriculomegaly on US, and a suspected intraventricular hemorrhage in one case. SWI demonstrated intraventricular hemorrhage in both cases. The third fetus was affected by cytomegalovirus infection and was found to have isolated microcephaly by US. However, conventional MR sequences demonstrated diffuse cortical dysplasia, while SWI showed parenchymal hemorrhage, which had not been clearly identified by conventional sequences. SWI was also useful in differentiating parenchymal intracranial hemorrhage from calcification. In all three cases, SWI was superior to US and conventional MR sequences in identifying and confirming intracranial hemorrhage.

Conclusion

Fetal SWI is superior to US and conventional MR sequences in the detection of intracranial hemorrhage. SWI of the fetal brain may be an important tool for reliable identification of intracranial hemorrhage, and may help differentiate this from calcification.

Three-dimensional ultrasound scan (3D US) assessment. A ‘must’ for corpus callosum agenesis (CCA) diagnosis? As good as magnetic resonance imaging (MRI)?

M. Petrache1, C. Bradeanu2, A. Ene3

1Gineconsult SRL/ Polizu Teaching Hospital, Bucharest, Romania, 2Sanador Medical Center, Bucharest, Romania, 3Medlife Medical Center, Bucharest, Romania

Just trying to answer two questions about the importance of 3D US brain scanning and compare it with MRI, as this is a frequent used tool in fetal imaging, completing the US scan for intracranial imaging. 2/3D, MRI and histological images of few cases of CCA are used to emphasize the importance and some limitations of both investigation tools. The midline sagittal brain view and pericallosal artery visualization in 2D are consistent for CCA diagnosis, but ISUOG guidelines for CNS scanning do not include in this moment the midline brain sagittal view. What we routinely obtain is the transverse view with cavum septum pellucidum absence and tear drop ventricles as indirect signs. MRI would easily confirm the diagnosis of CCA, describe origin and density of intracranial structures inside brain. Once that 3D US have been introduced, similar brain images and sections could be demonstrated by US scan and by MRI. Beginning with the classical 3D US approach, of multiplanar view and continuing with VCI-C, TUI, Omni view, Inversion Mode Rendering and Glass Body Imaging, all these tools brought adjustments in the image quality and made examination time consuming, raising in the same time diagnosis accuracy. Both types of investigation are helpful in many differential diagnosis, follow ups and prognostics concerning intracranial examination, including partial CCA or digenesis. For complete CCA, though, 3D US scan is of great help and sufficient examination for diagnosis. MRI will still have the last decision in order to establish associated abnormalities and prognostic.

Periventricular leukomalacia and periventricular hemorrhagic infarction in the fetus

D. Pugash1, C. Mayer2, G. Hendson3, C. P. Dunham3

1Department of Radiology, University of British Columbia, Canada, 2Department of Obstetrics and Gynecology, University of British Columbia, Canada, 3Department of Pathology and Laboratory Medicine, University of British Columbia, Canada

Objectives

Periventricular leukomalacia (PVL) and periventricular hemorrhagic infarction (PVHI) are uncommonly reported during fetal life. The purpose of this study is to identify prenatal imaging features of PVL and PVHI in the fetus and to assess associated risk factors.

Methods

Prenatal imaging identified fetuses with findings suggestive of PVL and PVHI, which were correlated with postnatal imaging, clinical, and/or autopsy findings. Fetuses with cytomegalovirus were excluded.

Results

38 fetuses were identified by abnormal prenatal neurosonography and/or MRI. Evidence of intracranial hemorrhage was present in 14/38. PVHI was identified in 6 fetuses with intraventricular hemorrhage. PVL was present in 24. In 16/24 fetuses, PVL was extensive and diffuse. Complications of monochorionic twinning were present in 6, and hydrops fetalis was present in 6. 8 fetuses had focal PVL. 3/8 cases were associated with demise of a monochorionic co-twin. 2 fetuses had metabolic disorders and evidence of intracranial hemorrhage. 2/8 fetuses were exposed to teratogens. Four fetuses had focal periventricular white matter defects; these were associated with severe intraventricular hemorrhage and presentation late in the third trimester.

Conclusions

Targeted neurosonography provides high-resolution imaging of the fetal brain and is sensitive and effective in identifying fetuses with abnormal white matter from a variety of etiological insults. This is primarily accomplished by evaluating normal and abnormal transient laminar patterns of the fetal cerebrum between 17 and 30 weeks' gestation, with or without ICH.

Fetal white matter abnormalities in CMV infection

D. Pugash1, G. Hendson2, C. P. Dunham2, D. M. Money3

1Department of Radiology, University of British Columbia, Canada, 2Department of Pathology and Laboratory Medicine, University of British Columbia, Canada, 3Department of Obstetrics and Gynecology, University of British Columbia, Canada

Objective

The purpose of this study is to review prenatal imaging findings in white matter of fetuses with subsequently proven CMV infection.

Method

Institutional ethical approval was obtained to review prenatal sonographic and MRI findings of cerebral lamination in fetuses with abnormal intracranial findings and proven intrauterine CMV infection.

Results

Ten fetuses presented between 17 and 39 weeks. Echogenic bowel was noted in 6/10 fetuses before 24 weeks. Before 24 weeks, none of the fetuses had microcephaly. One fetus had ventriculomegaly and intracranial calcifications before 24 weeks. Abnormalities of the intermediate zone and subplate zone were suspected as early as 23 weeks in two fetuses, and in 8/8 fetuses examined between 24 and 28 weeks. In all 8 fetuses, abnormal appearances of the intermediate zone included increased echogenicity and inhomogeneity, hyperechogenic non-calcified foci, irregular thinning of the intermediate zone, and a spiculated appearance of the interface between the intermediate zone and subplate zone. After 28 weeks, there was evidence of cerebral volume loss in the occipital lobes and expansion of the occipital horns in 4/4 cases, and abnormal white matter signal intensity on fetal MRI in one case. In the 4 liveborn fetuses, white matter abnormalities were confirmed on postnatal MRI and CT scans. Postmortem correlation was obtained in 4 out of 6 cases.

Conclusions

Subtle abnormalities in echotexture of the laminar pattern of the future white matter between 23 and 28 weeks may be relatively early evidence of CMV-associated white matter injury.

Fetal meconium on MRI: when, where and how much? Establishing normative data

K. J. Timms, E. H. Whitby

Academic Unit of Reproductive and Developmental Medicine, University of Sheffield, UK

Objective

The use of fetal magnetic resonance imaging (MRI) for areas other than the central nervous system is rapidly expanding. When assessing the fetal bowel there is little, if any, normative data. Meconium has been shown to be an indicator of pathology in the bowel and is seen easily on a T1 weighted image, creating a hypersignal on the scan due to its composition. We aimed to obtain normative data for the amount of meconium seen in the fetal bowel at different gestational ages.

Methods

169 cases were reviewed both retrospectively (90) and prospectively (79) of which 106 were able to be analyzed. The images were processed using proprietary software (3DMIP volume viewer, GE, Milwaukee, USA) which allowed us to measure the meconium in 2D and to reconstruct the images in 3D, so that the 3D length could be measured. The length of bowel filled with meconium, the anatomical location with corresponding widths, the distance from the edge of the body and the widest point were noted of the 2D image. Length was also measured on the 3D reconstruction.

Results

The length of bowel filled with meconium measured on 3D increased with gestational age (R2 linear, 0.763). Although 3D and 2D were not equivalent, 2D showed a similar relationship (R2 linear, 0.753). Once the pathological outliers were removed the correlation coefficients were 0.868 and 0.874, respectively. There was also a fairly strong correlation between the widest point and GA with a correlation coefficient of 0.732. There was a difference between the 2D and the 3D measurements due to lengths of bowel which cannot be seen on a 2D image, which can be seen on the 3D image. This difference increased with gestational age due to the increased length of bowel filled with meconium that occurs as gestational age increases.

Conclusion

There is a clear relationship between the length of bowel filled with meconium and gestational age. There also appears to be a relationship between width and gestational age. This normative data could be used to generate a normal curve for quantity of meconium and be used to detect abnormal appearances that indicate pathology.

Posters

  1. Top of page
  2. Abstract
  3. Oral presentations
  4. Posters
  5. Morphometry of the posterior fossa and fractional anisotropy of the brainstem: parameters aiding in the differentiation between open and closed neural tube defects

Prenatal ultrasound and magnetic resonance in cleft lip and palate: a case report

C. Aliberti, E. Bevilacqua, V. D'Ambrosio, A. Giancotti, R. La Torre

Department of Obstetrics, Gynecology and Urologic Sciences ‘Sapienza’ University, Rome, Italy

Background

Facial clefts are among the most common congenital anomalies and represent a heterogeneous group of disorders. Prenatal detection is 48%. There is no commonly agreed method for fetal palate visualization.

Case report

A gravida 1 mother attended our Prenatal Diagnosis Center of Policlinico Umberto I. Two dimensional (2D) and three dimensional (3D) ultrasound scan detected bilateral cleft lip and palate, with maxillary bone protrusion. At 27 weeks of gestation fetal magnetic resonance (MRI) showed only paramedian cleft lip of 2,5 mm with extension on nasal root ipsilateral. Hard palate and left nasal root were apparently preserved. Postnatal finding was in accord with ultrasound, and the baby was treated with two surgical interventions without complications.

Conclusion

In our case, 2D and 3D ultrasound is sensitive, specific and effective for detection of cleft lip, soft or hard palate better than MRI. However, MRI may be ancillary in prenatal investigation of cleft lip.

Follow-up of fetal pathology on prenatal MRI

M. Bekiesinska-Figatowska1, A. Duczkowska1, I. Herman-Sucharska2, A. Romaniuk-Doroszewska1, R. Jaczyńska3, H. Bragoszewska1, J. Zamłynski4

1Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland, 2Department of Electroradiology, Collegium Medicum, Jagiellonian University, Krakow, Poland, 3Clinic of Obstetrics and Gynecology, Institute of Mother and Child, Warsaw, Poland, 4Clinic of Gynecology, Obstetrics and Oncological Gynecology, Silesian Medical University in Katowice, Bytom, Poland

Objective

To present own experience with prenatal MRI as a method of follow-up of fetal pathology.

Methods

Thirty fetuses underwent two prenatal MR examinations. First exams were performed at gestational age of 19–28 weeks (mean: 23.6 weeks), follow-up at 20-37th week (mean: 30.5). MRI was performed in two centers, using 1.5 T scanners. SSFSE/ T2-weighted images were the main diagnostic tool supported by TSE or GRE/T1-weighted images, diffusion-weighted imaging (DWI), steady-state free precession (FIESTA) and echoplanar GRE imaging (EPIGRE).

Results

In 5 cases MRI allowed exclusion of suspected pathology (brain anomaly in healthy fetus, septo-optic dysplasia in healthy fetus, right-sided CDH in case of left-sided pathology, pentalogy of Cantrell, lack of bladder in fetus with small, thick-walled bladder). In 4 cases additional pathology was detected on MRI as compared to US and followed (CCAM/pulmonary sequestration with self-regession, cerebellar hypoplasia, rhombencephalosynapsis, tethered cord with syringohydromyelia). In 3 cases MRI showed evolution of the disease (regression of intracerebral hemorrhage, progression of kidney disease). In 18 cases MRI was performed before and after open fetal surgery of myelomeningocele showing good outcome (in 10) and a spectrum of complications (in 8: from edema of the transplant in 4 to recurrent MC in 1).

Conclusions

Maternal uterus constitutes safe natural ‘incubator’ for fetus—it is easier and safer to perform it in utero, especially in late pregnancy, than in seriously sick newborn attached to life-supporting devices after birth. MRI is method of choice of diagnosis and follow-up in cases of open fetal surgery.

Magnetic resonance in prenatal diagnosis of corpus callosum anomaly

M. Bogavac, Z. Tatic-Stupar, A. Novakov-Mikic

University of Novi Sad, Medical Faculty, Clinical Centre of Vojvodina, Department of Obstetrics and Gynecology Novi Sad, Novi Sad, Serbia

Objectives

To show the role of prenatal sonography and magnetic resonance (MRI) in central nervous system (CNS) anomalies in a fetus, diagnostic procedures and a decision on the modus of pregnancy termination due to mother's heart disease.

Methods

Diagnosis of this anomaly of the central nervous system includes ultrasonographic diagnosis as well as its confirmation- magnetic resonance examination.

Case study

In gestational week (GW) 20 ventriculomegaly (VP 16mm left and 17 mm right) and a suspected partial agenesis of the corpus callosum was diagnosed by ultrasound. The pregnant woman had had a replacement of mitral valve 5 years before. In the GW26 a cordocentesis was done with antibiotic prophylaxis of the bacterial endocarditis. MRI examination confirmed ultrasonographic diagnosis of ventriculomegaly and partial agenesis of the corpus callosum. A foeticide was done with antibiotic protection. Obduction confirmed dysgenesis corpus callosum.

Conclusion

The case shows the importance of accurate prenatal diagnoses as well as at the need of a multidisciplinary approach to the decision on pregnancy termination modus in such cases.

The cerebellar vermis in cyclopean holoprosencephaly

P. C. Brugger1, G. M. Gruber1, B. Patzak2, D. Prayer3

1Center for Anatomy and Cell Biology, Medical University of Vienna, Austria, 2Federal Pathologic-Anatomical Museum, Vienna, Austria, 3Division of Neuroradiology, Department of Radiology, Medical University of Vienna, Austria

Objective

Few data are available concerning the cerebellum in holoprosencephaly (HPE). The present study investigated the cerebellar vermis in HPE associated with cyclopia-ethmocephaly-cebocephaly sequence.

Methods

Twenty-five formalin fixed fetal HPE specimens (26–38 gestational weeks (GW)) were studied using high resolution MRI. The vermis area was measured on sagittal images and compared with 581 fetuses (21–37 GW), which were studied with in vivo fetal MRI and had normal brains.

Results

The cerebellar vermis was hypoplastic and dysmorphic in the majority of cases (17/25), and was at the lower range of the respective GW in the remaining eight. Although there was a tendency for larger dimensions in older fetuses, there was considerable variation.

Conclusions

The brain malformation in cyclopean HPE is not limited to the structures derived from the prosencephalon, but also involves the cerebellar vermis in the majority of cases.

Severe second-trimester ventriculomegaly revealing obstruction related to pathologies of rhombencephalic, mesencephalic and diencephalic differentiation

M. Cagneaux1,2, A. Vasiljevic3, M. Massoud1, F. Allias3, J. Massardier1, P. Gaucherand1, L. Guibaud1,2

1Hôpital Femme Mère Enfant, Prenatal Diagnosis Multidisciplinary Center, Hospices Civils de Lyon, France, 2Hôpital Femme Mère Enfant, Pediatric and Fetal Imaging Department, Hospices Civils de Lyon, France, 3Hôpital Femme Mère Enfant, Pathology Department, Hospices Civils de Lyon, France

Objectives

To identify sonographic features suggestive of an obstructive mechanism in second-trimester foetuses with ventriculomegaly and describe developmental disorders related to pathological differentiation of the diencephalon, mesencephalon, and rhombencephalon which lead to obstruction of CSF flow.

Methods

Retrospective study of 11 fetuses with severe, second trimester ventriculomegaly of undetermined origin. Neurosonography included a detailed analysis of the third ventricle, thalami, aqueduct and cerebellum. Imaging data were correlated with neuropathology in 8 patients, with a focus on the level and etiology of the obstruction.

Results

Parenchymal lamination and reduction of the pericerebral spaces were highly suggestive of ventriculomegaly due to an obstructive mechanism. The ventriculomegaly was related to diencephalosynapsis (thalamic fusion and third ventricle atresia) in 5 cases and partial/complete aqueduct stenosis in 6, associated with cerebellar hypoplasia in 6, including rhombencephalosynapsis 2. In 9 patients, disorders of the diencephalon, mesencephalon, and rhombencephalon were combined.

Conclusion

When facing severe isolated ventriculomegaly, of which sonographic features are suggestive of an obstructive mechanism, close examination of the third ventricle, thalami, Sylvius aqueduct, and cerebellum may reveal pathologies of the diencephalon, mesencephalon or rhombencephalon, often in combination.

Placental invasion assessed by ultrasound and MRI: do the results depend on observer experience?

A. F. Cavaliere1, M. Tintoni1, P. Rosati1, L. Guariglia1, S. Buongiorno1, B. Gui2, M. Miccò2, A. L. Valentini2

1Department of Gynecology and Obstetrics, Catholic University of the Sacred Heart, Roma, Italy, 2Department of Radiology, Catholic University of the Sacred Heart, Roma, Italy

Objectives

The purpose of this study is to evaluate the diagnostic value of ultrasound and MRI in detecting suspected placental invasion and the role played by the operator.

Methods

Eleven pregnant women with placenta previa were assessed by two sonographers and two radiologists, blindly and independently, in terms of placental invasion and degree. Diagnosis of accreta was confirmed during CS and by histological examination.

Results

We observed 2 cases of placenta accreta and 9 cases of placenta previa without accreta. Ultrasound diagnosed correctly the 2 cases of placenta accreta, whereas MRI was uncertain in 6 out of 11 cases; in the remaining 5 cases MRI excluded accreta.

Conclusion

MRI can be a reliable and reproducible tool for placenta accreta, but it is not significantly different compared to US.

Outcome of 10 antenatally diagnosed fetal arachnoid cysts

B. De Keersmaecker1, P. Ramaekers2,7, F. Claus3, E. Ortibus4, G. Naulaers5, F. Van Calenbergh6, L. De Catte1

1Department of Obstet Gyn, University Hospital Leuven, Leuven, Belgium, 2Department of Obstet Gyn, University Hospital Antwerp, Antwerp, Belgium, 3Department of Radiology, University Hospital Leuven, Leuven, Belgium, 4Department of Pediatric Neurology, University Hospital Leuven, Leuven, Belgium, 5Department of Pediatric Neurosurgery, University Hospital Leuven, Leuven, Belgium, 6Department of Neonatology, University Hospital Leuven, Leuven, Belgium, 7Department of Obstet Gyn, University Hospital Ghent, Ghent, Belgium

Objectives

To investigate the natural history, associated abnormalities and outcome in fetuses diagnosed antenatally with arachnoid cyst. To correlate ultrasound and MRI reviews.

Methods

Retrospective study of 10 cases with antenatally detected fetal arachnoid cysts in a 5 year period. Associated abnormalities, additional MRI findings, pregnancy outcome and postnatal follow up were recorded.

Results

The median gestational age of diagnosis was 27 + 5/7 weeks. A total of 7 were suprasellar while 2 were located in the posterior fossa and 1 was at the temporal lobe. 7/10 were female. In 8/10 cases fetal MRI was performed and brain compression was confirmed in 3/4 cases. One pregnancy was terminated due to major anomalies.

Conclusions

Diagnosis of arachnoid cysts in the second trimester of pregnancy are of benign origin without the need of surgical intervention before birth. Absence of other associated anomalies and normal karyotype had a favorable postnatal outcome. MRI serves as a complementary tool.

The outcome and course of pregnancies complicated with anomalies of the central nervous system of fetus

J. Dukanac Stamenkovic1,2, S. V. Petronijevic1,2, M. Steric2, M. Petronijevic1,2, A. Ljubic1,2, L. Srbinovic3

1Medical Faculty, University of Belgrade,Belgrade, Serbia, 2Clinic for GYN/OB, Clinical Center of Serbia, 3Clinic for GYN/OB, Narodni Front, Belgrade, Serbia

Background

Malformations of the central nervous system are among the most frequent congenital disorders (prevalence of 1 / 100 to 1 / 500 newborns). The prevalence of CNS pathology in early pregnancy is higher than postnatally as some of these are associated with intrauterine demise.

Methods

143 pregnant women with US suspected central nervous system abnormalities of the fetus were identified and divided into 3 groups following the accuracy of US findings.

Results

The most common central nervous system anomalies were ventriculomegalies, which was 43%. Eighty-five pregnancies were terminated which presents 59% of all pregnancies included, 55 (39%) pregnancies resulted in living children, 2 (1.4%) children died in early neonatal period, and one child with agenesis of corpus callosum and pseudoporencephalic cyst was stillborn (0.6%). Group 1 included 67% of cases, Group 2 19%, and Group 3 14% .

Conclusion

The ultrasonographic diagnosis was confirmed in 86% of cases, while in 14% of it was wrong.

Impact of prenatal combined imaging by ultrasound and magnetic resonance on diagnosis of fetal CNS anomalies

V. Frisova1,2, L. Hornofova3, I. Spalova4, L. Haakova5, D. Smetanova6, M. Rocek2

1Profema - Fetal Medicine Centre Ltd, Prague, Czech Republic, 22nd Faculty of Medicine, Charles University and University Hospital Motol, Department of Radiology, Prague, Czech Republic, 32nd Faculty of Medicine, Charles University and University Hospital Motol, Institute for Pathological Anatomy and Molecular Medicine, Prague, Czech Republic, 42nd Faculty of Medicine, Charles University and University Hospital Motol, Department of Gynaecology and Obstetrics, Prague, Czech Republic, 5Institute for the Care of Mother and Child, Fetal Medicine Unit, Prague, Czech Republic, 6GENNET, Fetal Medicine Unit, Prague, Czech Republic

Objectives

1.To evaluate the impact of combined imaging by ultrasound and MRI on prenatal diagnosis of fetal CNS anomalies. 2. To compare the effectiveness of specialized neurosonogram by ultrasound and MRI in diagnosis of fetal CNS anomalies.

Methods

78 pregnancies were referred to our clinic due to suspected or diagnosed fetal CNS anomaly. 2D/3D ultrasound and MR imaging were performed on the same day by the same operator specialized in fetal medicine. Only cases with known outcomes were included into the analysis of impact of combined, ultrasound and MR imaging.

Results

Postnatal confirmation was available in 42 cases (53.8%). 32 (76%) pregnancies ended in live-birth, 1 in neonatal death, 3 in intrauterine death and 6 pregnancies were terminated. There were 20 (48%) healthy neonates, 10 (24%) neonates with single isolated CNS anomaly and 12 (28%) with multiple-systems anomalies (4 chromosomal abnormalities). There was 86% agreement between postnatal and our combined diagnosis and only 62% agreement between referral and postnatal diagnosis.

Conclusions

There was similar effectiveness of both ultrasound and magnetic resonance imaging. Both imaging were complimentary and their combination improved our confidence in the correct prenatal diagnosis.

The expanding indications for fetal brain MRI: a comprehensive evaluation and classification

I. Gat1, C. Hoffmann2, D. Shashar1, L. Zilka2, E. Konen2, R. Achiron1, E. Katorza1

1Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, 2Department of Radiology, Sheba Medical Center, Tel HaShomer, Ramat Gan, Israel, affiliated to Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Objective

The use of magnetic resonance imaging (MRI) during pregnancy impressively evolving. Although indications for fetal brain MRI were described, data regarding their expanding is limited. The aim of this study was to evaluate and classify the indications for fetal brain MRI in a tertiary referral center.

Methods

Retrospective study during two years period (2011–2012) in one tertiary medical center, included women who underwent fetal brain MRI after performing fetal neurosonogram by specialized gynecologist in the field of fetal imaging.

Results

635 patients were included, 45 (7.1%) had repeated examinations with total of 813 fetal scans. Patients were classified according to fetal brain MRI indication as follows: lateral ventricles (23.4%), TORCH exposure (17.6%), cerebral cortex (13%), MCBA (8.5%), body anomaly (6.8%), genetic (6.4%), midline structures (6%), posterior fossae (5.5%), IUGR (4.7%), supratentorial cyst (3%), head or face anomaly (1.9%), fetal evaluation (0.9%), craniosynostosis (0.8%), NTD (0.6%), reduced uterine perfusion D/T maternal hypotension (0.6%), brain tumor (0.3%).

Conclusion

The current research describes a detailed picture of fetal brain MRI indications. Most patients were referred because of located anomaly. The diversity of 16 separate entities emphasizes the expanding use of MRI. Monochorionic diamniotic pregnancies, which may have dramatic complications, constitute a unique challenge due to early and repetitive examinations and may serve as a role model for the MRI contribution to antenatal evaluation.

Growth of the fetal vermis

G. M. Gruber1, D. Prayer2, M. Weber3, P. C. Brugger1

1Center for Anatomy and Cell Biology, Medical University of Vienna, Austria, 2Division of Neuroradiology, Department of Radiology, Medical University of Vienna, Austria, 3Department of Radiology, Medical University of Vienna, Austria

Objective

Knowledge of normal growth and size of the fetal vermis is essential in assessing posterior fossa malformations. The aim of the present study was to establish reference data for the fetal vermis area based on a larger fetal sample.

Methods

In 581 fetal MRI studies (gestational week (GW): 21–37) with normal brain development (22–43 cases/GW, average: 34.1/GW) the vermis area was measured on exact mid-plane images of T2-weighted or steady-state free-precession sequences.

Results

From 21 to 37 GW growth of the cerebellar vermis area followed linear function (vermis area = −2.243 + 0.422*GW). Growth curves were computed. Compared to published ultrasound data the present values were smaller.

Conclusions

The presented reference values for each GW between 21 and 37 GW help to assess the vermis in case of posterior fossa malformations on MRI. The differences to data obtained by ultrasound underline the need for specific MRI reference data.

Postmortem fetal MRI diagnosis of VACTERL association

G. M. Gruber1, P. C. Brugger1, M. Mailath-Pokorny2, F. Stuhr3, D. Prayer3

1Center for Anatomy and Cell Biology, Medical University of Vienna, Austria, 2Department of Obstetrics and Gynecology, Medical University of Vienna, Austria, 3Division of Neuroradiology, Department of Radiology, Medical University of Vienna, Vienna, Austria

To underline the importance of postmortem MRI we present a case report as example. A 31 year old woman had premature rupture of membranes in gestational week (GW) 18 + 3 and fetal MRI was performed on a 1,5 Tesla unit in GW 21 + 5. MRI confirmed the US finding of a dysplastic right kidney and in addition revealed left-sided hydronephrosis with hydroureter, lung hypoplasia and asymmetric growth restriction. Anhydramnios prevented more detailed assessment. After termination of pregnancy at GW 22 + 5 a postmortem MRI was performed on a 3 Tesla unit. It revealed multiple malformations compatible with VACTERL association. This case illustrates that postmortem MRI has the potential to complete the clinical findings and offers important additional information especially when in utero assessment is limited or when parents decline conventional autopsy.

Growth of the fetal brainstem on MRI

G. M. Gruber1, D. Prayer2, M. Weber3, P. C. Brugger1

1Center for Anatomy and Cell Biology, Medical University of Vienna, Austria, 2Division of Neuroradiology, Department of Radiology, Medical University of Vienna, Austria, 3Department of Radiology, Medical University of Vienna, Austria

Objective

Since the fetal brainstem may be involved in several cerebral pathologies, the present study aimed to establish normative data for the dimension of the fetal pons from gestational week (GW) 21 to 37 based on a larger series of fetuses.

Methods

522 fetuses (16–42 fetuses/GW) without cerebral pathologies had in vivo magnetic resonance imaging (MRI). The maximum sagittal diameter of the pons was measured on high resolution T2-weighted mid-plane images.

Results

The sagittal pons diameter increased more than twofold in a linear fashion (equation: pons diameter = −2.243 + 0.422*GW), from a mean of 6.5 mm in GW 21 to 13.3 mm in GW 37. Nomograms were computed.

Conclusion

The presented reference values for fetal brainstem dimensions on MRI will aid the assessment of pathologies involving the pons, since visual assessment may be difficult in less conspicuous cases, especially when the normal shape is preserved.

Ventricular width in fetal corpus callosum agenesis

G. M. Gruber1, D. Prayer2, G. Kasprian2,3, P. C. Brugger1

1Center for Anatomy and Cell Biology, Medical University of Vienna, Austria, 2Division of Neuroradiology, Department of Radiology, Medical University of Vienna, Austria, 3Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas, USA

Objective

Corpus callosum agenesis (CCA) is considered to be associated with characteristic widening of the lateral ventricles known as colpocephaly. The present study analyzed the maximum width of the lateral ventricles (MWLV) in fetal CCA with magnetic resonance imaging (MRI).

Methods

In 102 fetal MRI studies (20–38 gestational weeks (GW)) MWLV was measured on frontal T2-weighted images and correlated with GW.

Results

MWLV was invariably located at the atrium or occipital horns. Although considerable variation was present, there was a tendency to increase with gestational age. In the whole series 19 cases had MWLV less than ≤ 10 mm, in two cases no colpocephaly was present.

Conclusions

MWLV in fetal CCA is variable and increases with GW. Furthermore, colpocephaly, usually considered to be associated with CCA, may be absent. This implies that the absence of the occipital forceps itself may not be responsible for the development of colpocephaly.

DALI – 1st data: ultrasound (US) and magnetic resonance imaging (MRI) measurements in early detection of fetal fat accumulation in obese pregnant women

J. Harreiter1, V. Berger-Kulemann2, C. Worda3, D. Bancher-Todesca3, D. Prayer2, A. Kautzky-Willer1 on behalf of the DALI Core Investigator Group

1Medical University of Vienna, Department of Endocrinology and Metabolism, Vienna, Austria, 2Medical University of Vienna, Department of Radiology, Vienna, Austria, 3Medical University of Vienna, Department of Obstetrics and Gynecology, Vienna, Austria

Objective

Aim of the study was to compare certain US and MRI measurements in obese pregnant women.

Methods

MRI and US measurements were performed between 28–30 weeks gestation. 9 patients participating in the DALI (Vitamin D and Lifestyle Intervention for Gestational Diabetes Mellitus (GDM) Prevention) study have been included to date.

Results

Mean BMI of mothers 32.0 (3.6) kg/m2. Mean weight gain during pregnancy was 6.8 (4.4) kg. Liver length (FLL), amniotic fluid index, abdominal and subscapular fat (SCF), femur fetal fat mass (FFM) and humerus FFM measured with US were 3.6 (0.5) cm, 17.2 (4.3) cm, 3.07 (0.82) mm, 3.04 (0.92) mm, 3.58 (1.31) cm2 and 2.55 (0.46) cm2. Fetal fat measured with MRI at extremities and body was 2.48 (0.51) mm and 2.41 (0.38) mm. Maternal BMI correlated positively with femur FFM (r= 0.68, p=0.043). FLL in US correlated positively with foetal SCF in US (r=0.71, p=0.048). No correlations occurred between fetal fat accumulation (FFA) in US and MRI.

Conclusion

FFA appears to be higher in US than in MRI in obese mothers. Based on small sample size behind this preliminary data further research is needed to validate these findings.

Moderate ventricular abnormalities: associated findings and prognosis based on frontal horn dilation

M. Illa, E. Eixarch, M. Sanz, S. Angles, A. Fervienza, B. Puerto, E. Gratacos

Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetrícia i Neonatologia (ICGON), Hospital Clinic, Barcelona, Spain

Objective

The aim of this study was to evaluate associated findings and prognosis based on frontal horn dilation in moderate ventricular abnormalities.

Methods

136 pregnancies diagnosed with moderate ventricular abnormalities including: mild ventriculomegaly, ventricular asymmetry and borderline atrial size. Frontal horns were measured transvaginally in a mid-coronal plane (transcaudal section); dilatation was considered with a width > 3.5 mm. Our sample was divided into those with moderate ventricular abnormalities with and without frontal horn dilation.

Results

There were 92 cases of moderate ventriculomegaly. 24 cases of borderline atrial size, and 20 cases of ventricular asymmetry. Gestational age was 27.1 weeks (20.0–39.7). Average atrial width was 10.8±1.5 mm and 58% of the cases presented a frontal horn enlargement. During follow-up, we observed an increased incidence of major abnormalities in those cases with dilated frontal horns compared to the non-dilated frontal horn group (32.5% vs. 7.3%, p= 0.003).

Conclusion

Based on this study, the size of frontal horns should be taken in consideration in neurosonographic studies to refine the prognosis in moderate ventricular abnormalities.

3.0-Tesla fetal MRI complements fetal ultrasound – 4 case reports

F.A.R. Jansen1, M.C. Haak1, F.T. de Bruïne2, C.M.P.C.D. Peeters-Scholte3

1Department of Obstetrics, Prenatal Diagnosis and Fetal Therapy, Leiden University Medical Center, Leiden, the Netherlands, 2Department of Neuroradiology, Leiden University Medical Center, Leiden, the Netherlands, 3Department of Pediatric Neurology, Leiden University Medical Center, Leiden, the Netherlands

Fetal magnetic resonance has proven to be an important complementary imaging method to fetal ultrasound, especially regarding the fetal brain. Up to now, fetal MRI scans have mainly been performed on a 1.5 T scanner. Recently the use of a 3T MRI scanner has been reported for fetal imaging and specific absorption rates can be held within safety limits.3 The theoretical advantage over 1,5T MRI is quicker scanning time and better image quality, which is of paramount importance in fetal MRI. We demonstrate the use of 3T MRI in 4 cases: lobar holoprosencephaly, intracranial bleeding, prenatal stroke, and suspected hypoplasia of the cerebellum. Follow-up MRI postpartum is presented when available. 3-Tesla fetal cranial MR images were of excellent quality and contributed to establish the definitive diagnosis and treatment plan. With growing experience, 3T imaging could significantly benefit the diagnostic work up of fetal (intracerebral) abnormalities.

Prenatal MR morphology of occipital encephaloceles

G. Kasprian1,2, A. R. Mehollin-Ray1, A. N. Shetty1, J. L. Williams1, CI. Cassady1, W. Lee1

1Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas, USA, 2Division of Neuroradiology, Department of Radiology, Medical University of Vienna, Austria

Objective

To evaluate the fetal cerebral MR morphology in cases with occipital and parietal meningoencephaloceles.

Methods

The 1.5 Tesla MR examinations (T2w, T1w, EPI, DWI, diffusion tensor imaging—4 cases) of 13 cases (mean age: 26+3 weeks) with occipital/parietal meningoencephaloceles were retrospectively analyzed.

Results

Displaced structures included the occipital poles (5/13), occipital lobes bilaterally (2/13), parietal and occipital lobes (2/13), parietal or occipital lobe unilaterally (each 1/13), brainstem, cerebellum, temporal and occipital lobes (2/13). Typical features of Chiari III malformation were seen in 6/13 cases. A molar tooth-like configuration of the midbrain was present in 3/13, and kinking/rotation of the brainstem in 5/13. Tractography revealed the presence and position of sensorimotor tracts in 4/4 and parts of the corpus callosum in 3/4. Displaced brain tissue showed diffusion restriction in 8/9 with fronto-occipitally oriented tract like structures on DTI (3/4).

Conclusion

Fetal MRI permits detailed characterization of heterogeneous brain anomalies associated with occipital encephaloceles.

Fetal surgery in open neural tube defects – initial prenatal follow-up MRI findings

G. Kasprian1,2, A. R. Mehollin-Ray1, A. N. Shetty1, J. L. Williams1, C. I. Cassady1, W. Lee1

1Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas, USA, 2Division of Neuroradiology, Department of Radiology, Medical University of Vienna, Austria

Objective

To report initial follow-up MRI data, acquired before and after open neural tube defect (ONT) repair.

Methods

The diameter of cerebral ventricles (LVD), amount of extra-axial CSF space (ECSF) and the level of cerebellar vermian displacement (VD) were evaluated on pre- and post-operative 1.5 Tesla MRI examinations.

Results

Fetal repair of ONT (level L2-L5) was performed at 24 gestational weeks (mean GW). MRI was done preoperatively and 6GW (range: 4-8GW) after surgery. The average level of VD was C2. Post-operatively, 7/8 patients showed persistent cord tethering and 3/6 patients a T1-hyperintense covering at the repair site (after primary skin closure). The LVD increased 4 mm on average (range: 1–7 mm) in all (8/8) cases. 7/8 patients showed correction of VD.

Conclusion

Besides the correction of VD, increase in extra-axial CSF spaces was the most prominent change after fetal ONT repair. Counterintuitively, the LVD increased, emphasizing that fetal surgery may reverse some but not all features of Chiari 2 malformations.

Virtual angiography of the fetal brain using post-mortem MRI

E. Katorza1, Y. Salem2, D. Shashar1, Y. Gilboa1, R. Achiron1, C. Hoffmann2

1Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, 2Department of Radiology, The Chaim Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Background

Recently, postmortem MRI/CT imaging is used to replace traditional invasive autopsy examination. This may be an alternative in the 40% of cases which cannot be autopsied. Cerebral sinovenous thrombosis (CSVT) is a rare and significant condition in fetuses and is mostly diagnosed late during the second or third trimester.

Case report

We describe a unique case which presented prenatally using ultrasonography and MRI with severe ventriculomegaly and suspected thrombosis of the straight sinus. Parents were counseled by a multidisciplinary team and elected to terminate the pregnancy following approval of the ethics committee. On post-mortem conventional T1 and T2 sequences, at the location of the straight sinus a collection was seen, compatible with thrombosed sinus. Post-mortem 3D-MRA with contrast material succeeded to depict the arterial tree of the brain and upper body.

Conclusion

This new application of virtual angiography using post-mortem MRI highlights the possibility to evaluate vascular anomalies, which can be difficult to demonstrate prenatally or through conventional autopsy.

Coronal approach for measuring both fetal lateral ventricles: is there an advantage over the axial view?

E. Katorza1, N. Duvdevani1, J.-M. Jacobson2, Y. Gilboa1, C. Hoffmann2, R. Achiron1

1Antenatal Diagnostic Unit, Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel, 2Department of Radiology, The Chaim Sheba Medical Center, Tel Hashomer, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

Objective

To compare the measurements of lateral cerebral ventricular diameter using a traditional axial view, with measurements obtained in coronal plane, using ultrasound.

Methods

Prospective study of 144 fetuses, 77 routine scans, and 67 dedicated scans. In each, the distal lateral ventricle was measured in the ‘classical’ axial plane, whereas both ventricles were measured using a posterior coronal plane.

Results

Ventricular assessment was possible in 91% on the coronal plane. For the entire group, the mean width of the distal lateral ventricle on the axial plane was 7.9±1.9 mm versus 8.2±1.9 mm on the coronal plane [p-value <0.001]. On coronal images slight asymmetry of the ventricles was detected in the routine group (0.2 mm), and was even more significant in the referral group (1.6 mm).

Conclusion

Our study showed that coronal measurement has an advantage over the axial view in which only the distal ventricle is clearly visible and measurable.

Risk of inferior vena cava compression syndrome during fetal MRI in the supine position – a retrospective study

D. Kienzl1, G. Kasprian2,3, V. Berger-Kulemann2, P. C. Brugger4, M. Weber1, D. Bettelheim3, D. Prayer5

1Department of Radiology, Medical University of Vienna, Austria, 2Texas Children's Fetal Center and Baylor College of Medicine, Houston, Texas, USA, 3Department of Obstetrics and Feto-maternal Medicine, Medical University of Vienna, Austria, 4Center for Anatomy and Cell Biology, Medical University of Vienna, Austria, 5Division of Neuroradiology, Department of Radiology, Medical University of Vienna, Austria

Objective

Inferior-vena-cava-compression syndrome (VCCS) is a dreaded complication of fetal MR examinations. This study aimed to correlate the occurrence of VCCS with the grade of inferior vena cava (IVC) compression to provide reference data, which could serve as a basis for MR safety guidelines.

Methods

MR examinations of 56 pregnant women (median GW 27+4) were analyzed. The grade of IVC compression was determined by measuring the sagittal maternal IVC diameter at the level of L4/L5. Additionally, fetal-head position and right-sided uterus volume were analyzed.

Results

A non-compressed IVC was present in 1.8% (n=1), a diameter of 5-<10mm in 33.3% (n=19) and 1-<5mm in 64.9% (n=36). IVC diameter was independent of fetal-head position (p=0.99) and gestational age (r=0.33). VCI compression tends to increase with increased right-sided uterus volume (r=−0.328; p=0.014). Clinical assessment revealed no symptoms of VCCS in any patient.

Conclusion

Our data support the concept of physiological compensation of VCCS, since no association with any clinical symptoms was detected. Fetal MRI in supine position is safe.

Abnormal corpus callosum in the fetus: the tip of the iceberg

S. Kumbla, M. Fink

Medical Imaging Department, The Royal Children's Hospital, Melbourne, Australia

Objective

Anomalies of the corpus callosum are common in brain malformations. MR images were reviewed for range of abnormalities in fetuses with an abnormal corpus callosum.

Methods

Images of all fetuses with an abnormal corpus callosum recognized on MRI between Jan 2000 to December 2012 were retrospectively reviewed.

Results

We identified 41 cases and 2 cases were excluded due to non availability of images. Of the remaining 39 cases, 24 (62%) had associated findings. These include 9 (23%) patients with migrational anomalies, 9 (23%) patients with posterior fossa abnormalities. 6 fetuses were syndromic and 3 had a chromosomal abnormality. Some fetuses had multiple anomalies.

Conclusion

Anomalies of corpus callosum is rarely isolated. Our study shows that approximately two thirds of fetuses have associated anomalies and one fourth of them were syndromic or had a genetic abnormality.

Outcome in children with placental lesions in fetal MRI

N. Linduska1, A. Grill1, S. Dekan2, D. Prayer3

1Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria, 2Department of Radiology, Medical University of Vienna, Austria, 3Division of Neuroradiology, Department of Radiology, Medical University of Vienna, Austria

Objective

We performed a prospective cohort study to investigate the influence of placental lesions diagnosed in fetal MRI on perinatal outcome and long-term neurodevelopmental outcome.

Methods

In our study all fetal MRI examinations (n=187) of pregnancies with vascular placental lesions were included. Offspring was prospectively investigated by Bayley developmental scales at the age of 2 to 3.5 years corrected age.

Results

Mortality was predicted by earlier gestational age at fetal MRI for placental pathology (p < 0.05) and increasing extent of the vascular lesion (p < 0.05). Impairment rates were 32%. No correlation between neuro/motordevelopmental outcome at 2–3.5 years and type, extend or gestational week at the time of diagnoses of placental vascular pathologies were found.

Conclusion

MR detected vascular placental pathologies were associated with high perinatal mortality and impairment rates. The extent of placental involvement correlates with neonatal mortality, but not with the degree of impairment in survivors.

Is fetal magnetic resonance imaging indicated when isolated ventriculomegaly is detected on second- and third-trimester sonogram?

M. Mailath-Pokorny1, G. Kasprian2, P. C. Brugger3, D. Prayer2

1Department of Obstetrics and Gynecology, Medical University of Vienna, Austria, 2Division of Neuroradiology, Department of Radiology, Medical University of Vienna, Austria, 3Center for Anatomy and Cell Biology, Medical University of Vienna, Austria

Objective

To determine the impact of MRI in evaluating the fetus with a sonographic diagnosis of mild isolated ventriculomegaly (VM).

Methods

All consecutive fetuses with the sonographic diagnosis of mild (atrial width 10–12 mm) VM, who underwent additional MRI, were included. MR images were obtained on a 1.5 Tesla unit using a five-element, phased-array cardiac coil, including the following sequences: Coronal and sagittal single-shot T2-weighted (w) turbo-spin-echo (TSE) sequences; coronal and sagittal steady-state free-precession (SSFP) sequences (T2-w contrast); dynamic SSFP sequences.

Results

34 fetuses had sonographically detected mild VM (bilateral n=20; unilateral n=14). MRI added additional findings, which were missed on US, in 9 (9/31; 29.1%) cases: agenesis of the corpus callosum (n=4); lissencephaly (n=1); retrognathia (n=1). In 3 cases MRI added the cause of VM: infection (n=1); intracranial hemorrhage (n=2).

Conclusion

Our series shows that MRI provides important clinical information to the sonographic diagnosis of mild VM.

Prenatal unilateral cerebellar hypoplasia. Significance and implications for prenatal diagnosis. A prenatal series of 26 cases

M. Massoud, C. Garel, P. Gaucherand, V. Desportes, L. Guibaud

University of Claude Bernard Lyon1, Fetal Medicine Unit, HFME Lyon, France

Objectives

To define imaging pattern of unilateral cerebellar hypoplasia (UCH), underline possible etiologies and the prognosis in a prenatal series of 26 cases.

Results

Imaging follow up was typical of clastic lesions in 6 cases. Constant imaging pattern of UCH with cystic lesion of the posterior fossa was reported in 5 cases including 4 cases of PHACES syndrome. Abnormal foliation was noted in 6 cases. The surface loss of CH was >50% in 19 cases. The vermis was normal in 20 cases, abnormal in 6 cases. Based on collecting data, UCH was most likely related to primitive hemorrhagic or ischemic/hemorrhagic lesion, congenital CMV infection and to PHACES syndrome. Twenty three infants were alive, 15 had normal neurological outcome and 6 had abnormal outcome.

Conclusion

UCH is a focal lesion to the cerebellum that might be secondary to a clastic origin especially when imaging follow up reveals changes of imaging features. UCH can be a clue for the prenatal diagnosis of PHACES syndrome. The surface loss of CH is not correlated to bad prognosis and normal vermis is often associated with a normal outcome.

Placental perfusion increases upon a prenatal stress challenge in mice: is it an immune response?

C. Much1, E. Solano2, N. D. Forkert3, J. Sedlacik4, G. Adam1, P. Arck2, U. Wedegaertner1

1Department of Radiology, University Medical Center Hamburg-Eppendorf, Germany, 2Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Germany, 3Department of Computational Neuroscience, University Medical Center Hamburg-Eppendorf, Germany, 4Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany

Objective

Prenatal stress impairs fetal growth and maternal immune adaption during pregnancy in mice. We performed DCE-MRI in pregnant mice with and without mature immune systems, to measure changes in placental perfusion upon a prenatal stress challenge.

Methods

MRI was performed on a 7 Tesla scanner (ClinScan, Bruker, Germany) on 10 pregnant Balb/c mice and 10 Rag2−/− mice on gestational day (gd) 16.5. Of both groups 5 dams were exposed to an established model of stress challenge, 5 animals served as controls. For DCE-MRI, a contrast enhanced 3D T1-weighted gradient-echo sequence was used. After calculation of perfusion maps, a volume-of-interest analysis was performed to obtain average perfusion values for each placenta. A Mann–Whitney U test was applied.

Results

Placental perfusion increased significantly in Balb/c mice upon a stress challenge, compared to the control group (178 + 43ml/ml/min vs. 115 + 38 ml/ml/min) (p=0.0007). No significant difference was observed between the stress-challenged and control Rag2−/− mice (125 + 40 ml/ml/min vs. 110 + 22 ml/ml/min) (p=0.2).

Conclusions

Placental perfusion is significantly increased upon a prenatal stress challenge in mice. This suggests that the mechanism by which prenatal stress increases placental perfusion is mediated by a maternal immune response involving the T-, B- or NK-cell system.

Prenatal diagnostic imaging features of closed spinal dysraphism

D. Pugash1, P. Thiessen2, B. Irwin3, D. Cochrane4

1Department of Radiology, University of British Columbia, Canada, 2Department of Pediatrics, University of British Columbia, Canada, 3Children's and Women's Health Centre of British Columbia, Canada, 4Department of Neurosurgery, University of British Columbia, Canada

Objective

To observe fetuses with closed spinal dysraphism (CSD).

Methods

Fetuses with suspected CSD between 1997 and 2012 were identified.

Results

All fetuses were euploid. MSAFP was negative in 10 cases and elevated in 2 cases. AFAFP and ACE were elevated in 1 case. No Chiari II malformation was identified in 34/35. In 18/20 lumbosacral lesions, a low conus was appreciated. US of 20 spinal lipomas showed: cyst or mass (14); vertebral anomalies (14), intradural fat (11) and talipes (4). In 1 spinal lipoma, fat was not seen on fetal MRI (<24 weeks).

Conclusions

1. Characteristic intracranial abnormalities of OSD are absent. 2. MSAFP, AFAFP and ACE can be normal or elevated. 3. CSD is not associated with increased risk of aneuploidy. 4. Cystic/fatty masses, vertebral, and foot abnormalities are associated with CSD. 5. A low conus indicates lumbosacral CSD. 6. Spinal lipomas may not be visible before 24 weeks.

Fetal MRI at 3T: report of our experience

V. Ribeiro1, J. Teixeira1, C. Vasconcelos1, S. Pina1, R. Taipa2, M. Martins3, M. Céu Rodrigues3

1Service of Neuroradiology, Centro Hospitalar do Porto, Portugal, 2Neuropathology Unit, Centro Hospitalar do Porto, Portugal, 3Prenatal Diagnosis Center, Centro Hospitalar do Porto, Portugal

Objective

To present a brief overview of Centro Hospitalar do Porto, fetal MRI at 3T, that were referred for evaluation of pathologies involving CNS, face and neck and prenatal counseling.

Methods

Report 20 cases done between September 2010-January 2013, ranged 21–34 weeks gestation, performed on MR Philips with SENSE Torso 16 or cardiac coil 32 channels. Protocol acquisition: T2, T1, Diffusion, thick-slab, CINE, tractography. Sequences adjusted to low SAR, Sound Pressure Noise and PNS levels.

Results

Diagnosis were: corpus callosum agenesis (3), monosomy 1p36, rhombencephalosynapsis, Cornelia Lange syndrome, myelocystocele, Mega cisterna magna (2), fetal goiter, enteric cyst of the tongue, isolated cleft lip and palate of a twin, ventriculomegaly and thin corpus callosum (2), suspected Beckwith-Wiedemann Syndrome, brain malformation and diaphragmatic hernia, dolichocephaly, trisomy 18, two normals.

Conclusions

3T improved quality. Despite SAR restrictions, didn't interfere much in acquisition time or quality, but we had the benefit from multitransmission. In our practice, there was no significant advantage in clinical decision making of the 3T over 1.5T, but more experience is needed.

Inferior vermian hypoplasia – preconception, misconception

A. Robinson

BC Children's Hospital, Vancouver, Canada

Objectives

To propose and provide evidence for an alternative concept regarding development of the cerebellum, and to dispel several misconceptions regarding both normal and abnormal cerebellar development, with specific reference to the cerebellar vermis.

Methods

Examples of cerebellar and vermian anatomy by both sonography and fetal MRI were retrospectively reviewed, in both fetuses and in pre-term neonates between 8 and 40 weeks gestation. This was correlated with already established knowledge of cerebellar embryology, phylogeny, somatotopic mapping and functional MRI.

Results

The evidence indicates that the cerebellar vermis probably does not develop in a cranio-caudal direction, but rather in a ventral to dorsal direction, and therefore the concept of inferior vermian hypoplasia is probably incorrect.

Conclusions

As a result of terminology we have the preconception that the vermis grows from superior to inferior. The incorrect assumption follows that partial agenesis always involves the inferior lobules, whereas the evidence suggests that in many cases it is the central lobules that are actually deficient. In these cases ‘neo-vermian hypoplasia’ may be a more accurate description.

Cerebellar differences in term SGA fetuses assessed by fetal MRI and its association to neurobehavioral outcome

M. Sanz Cortes, M. Illa, G. Egaña-Ugrinovich, R. Zupan, F. Figueras, N. Bargallo, E. Gratacos

Department of Maternal-Fetal Medicine, Institut Clinic de Ginecologia, Obstetrícia i Neonatologia (ICGON), Hospital Clinic, Barcelona, Spain

Objectives

We tested the hypothesis whether term small for gestational age (SGA) fetuses present a different brain stem and cerebellar morphometry when compared with adequate for gestational age (AGA) and the association of these differences with their neurobehavioral outcome during the neonatal period.

Methods

MRI was performed on 51 SGA and 47 AGA fetuses at 37 weeks' GA. Pontine width, medullar width, vermian width and height, and primary cerebellar fissure's depth was measured and. corrected by biparietal diameter and compared between SGAs and AGAs. Cerebellar volume (CBV) was measured and corrected by total intracranial volume (TICV), comparison of the obtained ratios between cases and controls was carried out. Neonates underwent a Neurobehavioral assessment scale test (NBAS test) during the neonatal period. Association between cerebellar differences and neurobehavioral outcome was tested.

Results

All the biometries were significantly larger in SGA fetuses (Pontine width/BPD: SGAs 0.145±0.01 vs. AGAs 0.137±0.01; p0.01. Medullar width/BPD: 0.089±0.01 vs. 0.083±0.01; p<0.01. Vermian width/BPD:0.184±0.03 vs.0.169±0.02; p<0.01 Vermian height/BPD: 0.237±0.03 vs.0.222±0.02; p<0.01), with deeper fissures in SGAs (Primary cerebellar fissure/BPD: SGAs 0.021±0.01 vs.0.017±0.01; p<0.02). A trend for larger CBV/TICV in SGAs was also detected. Medullar and cerebellar biometries and volumetry were significantly associated with different NBAS cluster scores.

Conclusion

Brain stem and cerebellar morphometry in term SGA fetuses present significant differences, which are significantly associated to their neurobehavioral outcome.

Postmortem MRI of human fetal optic nerves and chiasm

C. A. Seitz1, G. M. Gruber2, M. Weber3, D. Prayer1

1Division of Neuroradiology, Department of Radiology, Medical University of Vienna, Austria, 2Center for Anatomy and Cell Biology, Medical University of Vienna, Austria, 3Department of Radiology, Medical University of Vienna, Austria

Objective

Optic structures abnormalities represent a leading cause of congenital blindness. Magnetic resonance imaging (MRI) measurements in postmortem fetuses can be used to establish reference values, which may allow identifying fetuses at risk. The aim of this study was to evaluate the normal dimensions of optical structures and the angle between the optic nerves in correlation to gestational age.

Methods

Sixty fetuses (15–42 gestational weeks) which underwent postmortem MR imaging on a 3 Tesla unit at our institution for clinical purposes were included in this retrospective study. Five different parameters of the optic nerves and chiasm were measured on axial and sagittal T2-weighted images.

Results

Our data showed that the dimensions of the optic nerves and chiasm increased with gestational age.

Conclusion

The age-dependent reference values obtained in this study may aid the interpretation of fetal optic nerve and chiasm pathologies and help identify hypoplasia of optical structures.

Fetal MRI: a rare case of caudal duplication

N. Stahr1, R. Guggenberger1, I. Scheer1, N. Ochsenbein2, C. J. Kellenberger1

1Department of Diagnostic Imaging, University Children's Hospital Zurich, Switzerland, 2Department of Obstetrics, University Hospital, Zurich, Switzerland

Objective

We report the case of a dipygus diagnosed by fetal-MRI with four lower extremities, two clubfeet and an omphalocele in a 28 year old woman in the 22th week of gestation.

Methods

A fetal-MRI was performed with axial, coronal and sagittal T2-weighted single shot fast spin echo images of the female pelvis, the fetus body and head, dynamic 2D fast imaging employing steady state acquisition and axial T1-weighted fast spoiled gradient echo of the female abdomen.

Results

Beside one pair of normal lower extremities with two clubfeet fetal MRI showed an additional and inversely oriented, hypoplastic pelvis caudal to the normal pelvis with two inversely oriented, hypoplastic, complete legs. Except for a small omphalocele no further abnormality was detected.

Conclusion

This complex malformation represents a rare type of caudal duplication i.e. dipygus with potential additional urogenital and gastrointestinal malformations.

Severe microhydranencephaly: differential diagnosis with anencephaly

L. Targa1,2, C. Grecco1, J. Picetti1, J. Telles1, R. Rosa1,3, A. da Cunha1, A. Gobatto4, T. Dal Pai4, C. Arcolini4, A. Bicca4

1Hospital Materno Infantil Presidente Vargas, Porto Alegre, Brasil, 2Tomo Clínica, Canoas, Brasil, 3Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil, 4Universidade Luterana do Brasil, Porto Alegre, Brasil

Objectives

The diagnosis of skull defects such as anencephaly, can be established by ultrasound in the first trimester of pregnancy, after the period of mineralization. Our aim was to report the prenatal findings of a fetus with microhydranencephaly.

Case report

A 32 year-old the pregnant woman had a previous US in gestational week 21 suspecting anencephaly. US performed at our hospital, at 24 weeks, identified the fetal skull, indicating microcephaly. Brain structures were not well defined, however, interhemispheric division was seen. At GW 28 polyhydramnios occurred. Fetal magnetic resonance imaging revealed severe atrophy of the cerebral hemispheres, thalamus, midbrain, cerebellum and brainstem, diffuse spinal cord atrophy and microcephaly and increased fluid in the nasopharynx and oropharynx. The child was born about 1 week later, and died soon after birth.

Conclusions

Severe microhydranencephaly may mimic anencephaly. This may have important implications for genetic counseling, because different etiologies may be involved, and, in Brazil, different legal issues related to the termination of pregnancy.

Neural tube defects evaluated by fetal ultrasound and magnetic resonance imaging

L. Targa1,2, C. Grecco1, J. Telles1, A. Gobatto3, A. Bicca3, R. Rosa1,4, C. Arcolini4, P. Fell1, M. Lisboa1, T. Dal Pai4

1Hospital Materno Infantil Presidente Vargas, Porto Alegre, Brasil, 2Tomo Clinica, Canoas, Brasil, 3Universidade Luterana do Brasil, Porto Alegre, Brasil, 4Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil

Objective

Neural tube defects are common congenital malformations caused by a failure of neural tube closure. Our aim was to report the findings observed in two fetuses with neural tube defects using ultrasound and magnetic resonance imaging (MRI).

Case reports

In the first case the sonographic evaluation at 26 weeks showed polyhydramnios, lemon and banana signs, and defective fusion of the spine at lumbosacral level. MRI revealed ectasia of the supratentorial ventricles, and herniation of the cerebellar vermis into the spinal canal. The postnatal ultrasound evaluation confirmed the ventriculomegaly. In the second case fetal ultrasound performed at 29 weeks showed lemon sign, ventriculomegaly, no cerebellum and a lumbosacral myelocele. MRI showed an agenesis of the corpus callosum, no septum pellucidum, dilatation of the lateral ventricles and cerebellar herniation into the spinal canal.

Conclusions

Our findings illustrate the importance of the combined use of magnetic resonance imaging in cases of fetal neural tube defects, especially for evaluation of brain findings.

Report of a fetus with occipital encephalocele associated with ventriculomegaly evaluated through two-dimensional ultrasound and magnetic resonance imaging

L. Targa1,2, C. Grecco1, J. Telles1, F. Enk3, K. de Oliveira3, R. Rosa1,4, A. Bicca3, P. Fell1, I. Marshall1, A. Weiss1

1Hospital Materno Infantil Presidente Vargas, Porto Alegre, Brasil, 2Tomo Clinica, Canoas, Brasil, 3Universidade Luterana do Brasil, Porto Alegre, Brasil, 4Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil

Objective

Encephalocele is one of the main types of neural tube defects and is characterized by the protrusion of the brain and/or meninges through a defect in the skull, closed or covered by skin. We report on a case with occipital encephalocele associated with ventriculomegaly assessed by two-dimensional ultrasound and magnetic resonance imaging (MRI).

Case report

At 25 gestational weeks ventricular dilatation was seen on ultrasound. At our institution an additional protrusion of brain tissue and liquid surrounded by membrane measuring 5.1 cm, compatible with an occipital encephalocele was seen. Fetal MRI at 29 weeks also showed an occipital encephalocele. Postnatally, the girl underwent surgery for correction of occipital encephalocele on the second day of life. She will need shunting for her hydrocephalus.

Conclusions

The prognosis for patients with occipital encephalocele depends on the extent of herniated cerebral tissue and the presence of associated anomalies. Therefore, the importance of more detailed assessment of these cases, using additional tests, such as MRI.

Neural tube defects as markers for trisomy 18 (Edwards syndrome)

L. Targa1,2, C. Grecco1, J. Telles1, M. Bacil1, S. Musa1, L. Vieira1, R. Rosa1,3, J. Picetti1, C. Bedin1, I. Marshall1

1Hospital Materno Infantil Presidente Vargas, Porto Alegre, Brasil, 2Tomo Clinica, Canoas, Brasil, 3Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil

Objective

Chromosomal abnormalities, such as trisomy 18 are observed in 7–16% of fetuses with neural tube defects. Our aim was to report the findings of a prenatal case of trisomy 18 associated with myelomeningocele.

Case report

At 25 weeks polyhydramnios and myelomeningocele were identified in the pregnant woman. Morphological ultrasound, at 28 weeks gestation, showed polyhydramnios, a lemon sign, supratentorial ventricular dilatation, suspect agenesis of the corpus callosum insecure identification of the cerebellum, and lumbosacral myelomeningocele. Fetal MRI showed additionally altered cerebral gyri and cerebellar herniation into the spinal canal. Karyotype showed a free trisomy of chromosome 18, compatible with Edwards syndrome. Fetal echocardiography performed soon after showed a ventricular septal defect of moderate to large size.

Conclusions

Neural tube defects have been observed in about 6-12% of cases of trisomy 18, and among them stands the myelomeningocele, as observed in our case.

Placenta adhered to the cephalic pole in a fetus with limb–body wall complex

L. Targa1,2, R. Severo1, J. Picetti1, C. Bedin1, A. da Cunha1, R. Betat1, R. Rosa1,3, J. Telles1, A. Weiss1, S. Pires1

1Hospital Materno Infantil Presidente Vargas, Porto Alegre, Brasil, 2Tomo Clínica, Canoas, Brasil, 3Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brasil

Objective

Limb–body wall complex (LBWC) is proposed as the cause of a variety of congenital anomalies, including abnormalities in skull and face. Our aim was to report the findings of a fetus with LBWC and a placenta adhered to its cephalic pole.

Case report

At gestational week 21 an ultrasound evaluation showed single umbilical artery, acrania associated with abnormal cerebral content, ocular hypertelorism, suspect encephalocele above the left orbit, cleft lip and a linear structure extending from the fetal forehead to the placenta, suggesting an amniotic band. Fetal magnetic resonance proved US findings. The delivered child showed syndactyly between second and third toes. A membrane stretching from the midline of the face passed through the brain and went to the placenta. The placenta gradually was decomposing and its removal was not possible due to its adherence to the nervous tissue. The child died at 4 days of life.

Conclusion

The findings presented by the patient are considered unusual. They influenced the decision the route of delivery and to avoid a traumatic outcome, especially for the mother.

Women's acceptance of fetal MRI in clinical and research setting

B. van der Knoop, J. de Vries

Dept of Obstetrics and Gynaecology, Neuroscience Campus Amsterdam, Research Institute MOVE, VU University Medical Center, Amsterdam, The Netherlands

Objective

We experienced numerous refusals in a study evaluating the value of brain MRI and ultrasound in fetuses at high risk of acquired brain anomalies. The present study aimed to determine acceptance of pregnant women to undergo MRI of the fetus.

Methods

Population based case–control study of women that were offered fetal MRI in research (cases) or clinical (controls) setting in 2012. Extensive information (indication, procedure and safety of MRI) was provided to the cases verbally and in writing; controls received concise verbal information on indication and procedure. All women were advised, but not obliged, to use sedatives.

Results

MRI was refused in 57% (32/56) of the cases and in 0/17 of the controls. Sedatives were refused in 50% (12/24) of the cases and 0/17 of the controls.

Conclusion

MRI is considered more burdensome than professionals realize. Future studies should evaluate which information on fetal MRI is supportive.

Fetal MRI: a valuable tool in detecting brain abnormalities?

M. van Doorn, E. Newsum, L. Reneman, C. Majoie

Academic Medical Center, Department of Radiology, Amsterdam, Netherlands

Objective

The purpose of this retrospective study was to correlate fetal brain MRI with prenatal ultrasound and postnatal MRI scans, when available.

Methods

Between March 2006 and January 2013, 86 fetuses with a gestational age range of 20–34 weeks were scanned with MRI prenatally, 17 of these patients were also scanned postnatally. T2-HASTE MRI-sequences were performed on a 1,5T MRI.

Results

Prenatal MRI scans (n=86) confirmed ultrasound findings in 73% of cases. The three most frequently found abnormalities on MRI were: ventriculomegaly (n=35), corpus callosum abnormalities (n=14) and posterior fossa abnormalities (n=11). In 17%, MRI revealed additional findings, namely: cerebellar hypoplasia, corpus callosum agenesis and hemorrhage. The 17 postnatal MRI scans revealed additional abnormalities in 47%. In 16 cases the patient died.

Conclusion

Fetal brain MRI showed additional findings as compared to prenatal ultrasound in 17% of cases. However, an additional 47% of abnormalities were detected on postnatal MRI.

Distortion of the interhemispheric fissure with impact of the inner border of the frontal lobe: significance and implications for prenatal diagnosis

N. Vinurel1, A. Van Nieuwenhuyse2, M. Cagneaux1,2, C. Garel3, E. Quarello4, O. Picone5, M. Ferry6, P. Gaucherand2, V. des Portes7, L. Guibaud1,2

1Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Service de Radiodiagnostic, France, 2Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Centre Pluridisciplinaire de Diagnostic Prénatal, France, 3Hôpital Armand Trousseau, Assistance Publique Hôpitaux de Paris, Service de Radiologie, France, 4Hôpital Saint Joseph, Marseille, Unité d'Échographies Obstétricales, France, 5Hôpital Antoine Béclère, Assistance Publique Hôpitaux de Paris, Service de Gynécologie Obstétrique, France, 6Hôpital Sud, CHU de Rennes, Département de Radiologie et d'Imagerie Médicale, France, 7Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Service de Neuropédiatrie, France

Objectives

To illustrate the significance of distortion of the interhemispheric fissure (DIHF) associated with impact of medial borders of the frontal lobes and discuss the relevance of DIHF in prenatal diagnosis.

Methods

18 cases (13 prenatal and 5 postnatal) presenting with DIHF were studied retrospectively to investigate associated biological and anatomical anomalies based on pre- and postnatal imaging.

Results

Anatomical anomalies associated with DIHF were identified in 16 cases including mainly midline anomalies (syntelencephaly [n=2], lobar holoprosencephaly [n=1], Aicardi syndrome [n=2], callous dysgenesis [n=1], septo-optic dysplasia [n=2], and Kalleman Demorsier syndrome [n=1]), but also schizencephaly (n=2), cortical dysplasia (n=1) and more complex cerebral malformations [n=3], including neural tube defect in 2 cases. 6p deletion was identified in a case without associated CNS anomalies and complex mosaicism in a case with synthelencephaly.

Conclusions

Routine analysis of the interhemispheric fissure on axial/coronal plane may provide a clue for diagnosis of cerebral anomalies, especially those involving the midline. If DIHF is ‘isolated’ based on prenatal ultrasound, MRI is mandatory for careful analysis of optic and olfactory structures and gyration. Karyotyping is also recommended.

Prenatal diagnosis of expansive intracranial lesion

S. Vrzic Petronijevic1,2, J. D. Stamenkovic1,2, M. Petronijevic1,2, D. Damjanovic3, M. Steric2, A. Ljubic1,2, L. Srbinovic4

1Medical Faculty, University of Belgrade, Belgrade, Serbia, 2Clinic for GYN/OB, Clinical Center of Serbia, Belgrade, Serbia, 3Center for Radiology and MR, Clinical Center of Serbia, Belgrade, Serbia, 4Clinic for GYN/OB, Narodni front, Belgrade, Serbia

Teratoma is one of the most common fetal tumors which originates from all three germinal layers. Brain teratomas usually occur with other fetal anomalies and result with either intrauterine death or early postnatal death. We have presented a case of mature teratoma of right maxillary sinus which penetrates into middle cranial fossa. The tumor was diagnosed in 21st week of gestation in pregnant women with ventricular septal defect who already has one child with cleft lip. Timely decision about the outcome of this pregnancy has been made possible by early detection of this tumor.

Morphometry of the posterior fossa and fractional anisotropy of the brainstem: parameters aiding in the differentiation between open and closed neural tube defects

  1. Top of page
  2. Abstract
  3. Oral presentations
  4. Posters
  5. Morphometry of the posterior fossa and fractional anisotropy of the brainstem: parameters aiding in the differentiation between open and closed neural tube defects

R. Woitek1, G. Kasprian1, M. Weber1, P. C. Brugger2, D. Bettelheim3, R. Seidl4, D. Prayer1

1Department of Radiology, Medical University of Vienna, Austria, 2Center for Anatomy and Cell Biology, Medical University of Vienna, Austria, 3Department of Obstetrics and Gynecology, Medical University of Vienna, Austria, 4Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Austria

Objective

Open and closed neural tube defects (ONTDs, CNTDs) need to be differentiated on fetal MRI due to their very different prognoses. The clivus-supraocciput angle and the fractional anisotropy (FA) of the midbrain may help in this differential diagnosis.

Methods

The clivus-supraocciput angle was measured in fetuses without spinal dysraphism (n=158), with ONTDs (n=32) and with CNTDs (n=15). The FA was measured in the midbrain of 75 fetuses without spinal dysraphism and in 14 fetuses with ONTDs.

Results

ONTDs differed significantly from CNTDs concerning the clivus-supraocciput angle (p<.001). Fetuses with normal CNS development did not differ significantly from ONTDs concerning the FA. We found a medium correlation between gestational age and both the clivus-supraocciput angle (r=.633; p<.001) and the FA (r=.46; p<.001).

Discussion

The clivus-supraocciput angle may become a valuable parameter in the differentiation between ONTDs and CNTDs. Differences concerning the FA have to be further investigated.