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Ultrafast MR Imaging of the Fetus

¹ Department of Radiology, University Hospital Zürich, Rämistr. 100, CH-8091 Zürich, Switzerland.
² Department of Obstetrics, University Hospital Zürich, CH-8091 Zürich, Switzerland.
³ Division of Biostatistics, University of Zürich, Sumatrastr. 30, CH-8006 Zürich, Switzerland.
⁴ Department of Pathology, University Hospital Zürich, CH-8091 Zürich, Switzerland.

View larger version (16K): [in a new window]   Fig. 1A. —Receiver operating characteristic curves. Graphs show diagnostic accuracy of ultrafast MR imaging for spinal canal (area under the curve [Az] = 1.00), brain (Az = 0.96), uterus and placenta (Az = 0.93), and lungs (Az = 0.91) (A) and face (Az = 0.83), urinary tract (Az = 0.79), extremities (Az = 0.77), and heart (Az = 0.63) (B). Points show sensitivity and specificity when 0-3 are diagnosed as normal and 4 and 5 as abnormal.

View larger version (17K): [in a new window]   Fig. 1B. —Receiver operating characteristic curves. Graphs show diagnostic accuracy of ultrafast MR imaging for spinal canal (area under the curve [Az] = 1.00), brain (Az = 0.96), uterus and placenta (Az = 0.93), and lungs (Az = 0.91) (A) and face (Az = 0.83), urinary tract (Az = 0.79), extremities (Az = 0.77), and heart (Az = 0.63) (B). Points show sensitivity and specificity when 0-3 are diagnosed as normal and 4 and 5 as abnormal.

View larger version (169K): [in a new window]   Fig. 2A. —193-day-old male fetus with cervical immature teratoma. Clinical findings included polyhydramnios and reduced fetal movement. After delivery at 205 days' gestation, intubation failed and neonate died. Sonogram shows large cervical tumor (arrows) with displacement of vessels.

View larger version (181K): [in a new window]   Fig. 2B. —193-day-old male fetus with cervical immature teratoma. Clinical findings included polyhydramnios and reduced fetal movement. After delivery at 205 days' gestation, intubation failed and neonate died. T2-weighted MR image reveals inhomogeneously hyperintense cervical mass. Note compression of cervical structures. Spinal canal is normal and mandible cannot be seen.

View larger version (46K): [in a new window]   Fig. 2C. —193-day-old male fetus with cervical immature teratoma. Clinical findings included polyhydramnios and reduced fetal movement. After delivery at 205 days' gestation, intubation failed and neonate died. Photograph shows ruptured tumor at lower right pole after false intubation, with subsequent inflation of tumor.

View larger version (172K): [in a new window]   Fig. 3A. —203-day-old female fetus with arachnoid cyst. Sonogram shows large septate cystic structure in posterior fossa, suggestive of Dandy-Walker deformity.

View larger version (159K): [in a new window]   Fig. 3B. —203-day-old female fetus with arachnoid cyst. T2-weighted axial MR image reveals septa within lesion, which were better visualized on sonography. However, MR imaging reveals better delineation of cortical structures.

View larger version (148K): [in a new window]   Fig. 3C. —203-day-old female fetus with arachnoid cyst. T2-weighted MR image reveals normal size of fourth ventricle (arrow), excluding Dandy-Walker deformity.

View larger version (166K): [in a new window]   Fig. 4A. —252-day-old male fetus with watershed infarction detected during routine MR pelvimetry. Prenatal sonography revealed normal findings. T2-weighted coronal MR image reveals atypical head position (probably unrelated to final diagnosis) that prompted MR imaging.

View larger version (162K): [in a new window]   Fig. 4B. —252-day-old male fetus with watershed infarction detected during routine MR pelvimetry. Prenatal sonography revealed normal findings. T2-weighted axial MR image reveals findings suggestive of watershed infarctions of left hemisphere.

View larger version (141K): [in a new window]   Fig. 4C. —252-day-old male fetus with watershed infarction detected during routine MR pelvimetry. Prenatal sonography revealed normal findings. Postnatal T2-weighted MR image reveals findings that confirm prenatal MR imaging findings.

View larger version (142K): [in a new window]   Fig. 5A. —159-day-old male fetus with congenital fibrosarcoma of thigh. Pregnancy was terminated. Sonogram shows large tumor (arrows) of thigh and destruction of femur.

View larger version (107K): [in a new window]   Fig. 5B. —159-day-old male fetus with congenital fibrosarcoma of thigh. Pregnancy was terminated. T2-weighted MR image reveals large tumor (arrows) of thigh and no other deformities. Assessment of femur was inconclusive.

View larger version (40K): [in a new window]   Fig. 5C. —159-day-old male fetus with congenital fibrosarcoma of thigh. Pregnancy was terminated. Photograph reveals large tumor. Histologic findings confirmed fibrosarcoma.

View larger version (139K): [in a new window]   Fig. 6A. —29-year-old woman with septate uterus and 221-day-old female fetus with lobar holoprosencephaly. Sonography (not shown, performed at outside institution) revealed extensive hydrocephalus. Mother was referred for MR imaging. T2-weighted MR images show placenta (arrow, A) located at ventral aspect of uterus and incomplete fibrous uterine septum (arrowheads, B). Fetus is lying with head in left uterine horn and umbilical cord surrounding neck. Lobar holoprosencephaly with hydrocephalus was diagnosed. No other deformities were present, and primary cesarean section was performed at 221 days' gestation because of breech presentation and uterus deformity.

View larger version (155K): [in a new window]   Fig. 6B. —29-year-old woman with septate uterus and 221-day-old female fetus with lobar holoprosencephaly. Sonography (not shown, performed at outside institution) revealed extensive hydrocephalus. Mother was referred for MR imaging. T2-weighted MR images show placenta (arrow, A) located at ventral aspect of uterus and incomplete fibrous uterine septum (arrowheads, B). Fetus is lying with head in left uterine horn and umbilical cord surrounding neck. Lobar holoprosencephaly with hydrocephalus was diagnosed. No other deformities were present, and primary cesarean section was performed at 221 days' gestation because of breech presentation and uterus deformity.

View larger version (161K): [in a new window]   Fig. 6C. —29-year-old woman with septate uterus and 221-day-old female fetus with lobar holoprosencephaly. Sonography (not shown, performed at outside institution) revealed extensive hydrocephalus. Mother was referred for MR imaging. T2-weighted MR images show placenta (arrow, A) located at ventral aspect of uterus and incomplete fibrous uterine septum (arrowheads, B). Fetus is lying with head in left uterine horn and umbilical cord surrounding neck. Lobar holoprosencephaly with hydrocephalus was diagnosed. No other deformities were present, and primary cesarean section was performed at 221 days' gestation because of breech presentation and uterus deformity.

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