MRI of Fetal CNS Abnormalities

Overview

Magnetic resonance (MR) imaging is a valuable complement to ultrasound when additional information is needed to make treatment decisions during pregnancy. In the past studies were limited by fetal motion. Due to fast imaging techniques now available, images can be obtained in less than 1/2 a second. This means that neither the mother nor the fetus needs to be sedated.

One area where MR imaging has proven to be especially beneficial is in evaluation of the fetal CNS . Multiplanar views can be difficult to obtain with sonography due to fetal position or advanced gestational age. MR imaging can be used to obtain multiplanar views. In addition, MR imaging allows for direct visualization of the brain parenchyma and thus allows for detailed evaluation of the CNS anatomy in a manner not possible with sonography.

There is no known risk to fetal MRI, but due to theoretic concerns, we avoid scanning in the first trimester.

Word to Date

In an ongoing study, we are evaluating fetal CNS abnormalities with ultrasound and MR imaging. In many cases, the information provided by MR imaging is of the type which warrants changes in patient counseling or management.

Encephalocele

ru1Sagittal view of a posterior encephalocele in a 32 week gestational age fetus. Only a small portion of posterior cortex is tented toward the defect. At surgery, the encephalocele was removed and a small portion of cortex was pushed back into the cranial vault without difficulty. Reproduced with permission from AJR 1999;172:813-818.

Agenesis of the corpus callosum

Agenesis of the corpus callosum in a 32 week fetus, incorrectly diagnosed as holoprosencephaly by ultrasound.

ru2Oblique axial fetal MR with HASTE (half Fourier acquisition single shot turbo spin echo) demonstrates unfused thalami (t), a falx anteriorly and vertical configuration of the frontal horns consistent with agenesis of the corpus callosum.


ru2bSagittal MR shows a dorsal cyst and a cleft lip. Agenesis of the corpus callosum can be difficult to diagnosis with ultrasound. Reproduced with permission from Radiology 1997;204:635-642.

Porencephaly - Destruction of brain tissue

ru3bModerate ventriculomegaly with porencephaly in a 38 week gestational age fetus. Sonogram showed only moderate ventriculomegaly. Coronal MR demonstrates porencephaly (destruction of brain tissue). Reproduced with permission from Radiology 1997;204:635-642.

Partial absence of the septi pellucidi

ru4bPartial absence of the septi pellucidi in a 32 weeks gestational age fetus. Axial, coronal and sagittal MR images demonstrates that only the inferior portions of the septi pellucidi are visualized The sagittal MR shows a normal corpus callosum. Reproduced with permission from Radiology 1997;204:635-642.

Indications:

When a fetus has an anomaly that is not well visualized by ultrasound, an MRI may be helpful. Your obstetrician can order the study. We also have a NIH study for fetuses with enlarged cerebral ventricles in which the cost of the MR examination is paid for by an NIH grant, NIBIB 01998.

Contacts

To schedule an examination or for questions about the study: Contact D. Levine, MD at 617-667-8901.