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How Accurately Does Current Fetal Imaging Identify Posterior Fossa Anomalies?

¹ Fetal-Neonatal Neurology Research Program, Department of Neurology, Children's Hospital Boston and Harvard Medical School, Boston, MA.
² Present address: Division of Pediatric Neurology, Montreal Children's Hospital, 2300 Tupper St., A-334, Montreal, QC H3H 1P3, Canada.
³ Present address: Department of Neurology and Neurosurgery, School of Physical and Occupational Therapy and Department of Pediatrics, McGill University, Montreal, QC, Canada.
⁴ Department of Radiology, Children's Hospital Boston and Harvard Medical School, Boston, MA.
⁵ Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
⁶ Advanced Fetal Care Center, Children's Hospital Boston and Harvard Medical School, Boston, MA.

OBJECTIVE. The first objective of our study was to describe the prevalence and spectrum of posterior fossa anomalies over 5 years in a major fetal care center where the referral diagnosis (by fetal sonography) was investigated by fetal MRI and, if confirmed, by postnatal MRI if possible. The second objective was to assess the accuracy with which fetal MRI predicts postnatal MRI findings in this population.

MATERIALS AND METHODS. We retrospectively identified all cases of suspected fetal posterior fossa anomalies referred to our center from 2002 through 2006. We reviewed maternal, fetal, neonatal, and follow-up records of all cases and fetal and early postnatal imaging studies.

RESULTS. Of the 90 cases of suspected fetal posterior fossa anomalies (by fetal sonography) referred over the study period, 60 (67%) were confirmed by fetal MRI. Of 42 live-born infants, 39 (93%) underwent postnatal MRI. There was complete agreement in fetal and postnatal MRI diagnoses in 23 infants (59%). In 16 cases (41%), fetal and postnatal MRI diagnoses disagreed; postnatal MRI excluded fetal MRI diagnoses in six cases (15%) and revealed additional anomalies in 10 cases (26%).

CONCLUSION. Although a valuable adjunct to fetal sonography in cases of suspected posterior fossa anomaly, current fetal MRI, particularly in early gestation, has limitations in accurately predicting postnatal MRI abnormalities. Advancing the accuracy of MRI for the diagnosis of posterior fossa anomalies will require greater understanding of normal brain development and improved tissue resolution of fetal MRI. During the interim, our findings strongly support the need for postnatal MRI follow-up in cases with suspected posterior fossa anomalies by fetal MRI.

Keywords: brain development • cerebellum • fetal MRI • fetal sonography • obstetrics • pediatric imaging • posterior fossa anomalies

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