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MR Imaging of Fetal Sacrococcygeal Teratoma

Diagnosis and Assessment

Fred E. Avni1, Laurent Guibaud2, Yann Robert3, Valérie Segers4, France Ziereisen1, Marc-Henri Delaet5 and Thierry Metens6

1 Department of Pediatric Imaging, University Children Hospital Queen Fabiola, 15 Ave. J J Crocq, 1020 Brussels, Belgium.
2 Department of Pediatric Imaging, Debrousse Hospital, 29 Rue Soeurs Bouvier, 69004 Lyon, France.
3 Department of Pediatric Imaging, Jeanne de Flandre Hospital, Ave. Eugène Aimée, 59037 Lille-Cedex, France.
4 Department of Pathology, University Children Hospital Queen Fabiola, 1020 Brussels, Belgium.
5 Department of Pediatric Surgery, University Children Hospital Queen Fabiola, 1020 Brussels, Belgium.
6 Department of Medical Imaging, Erasme Hospital, 808 Rte. de Lennik, 1070 Brussels, Belgium.



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  		Fig. 1A. —Female fetus at 32 weeks' gestational age with type III sacrococcygeal teratoma. Sagittal sonogram of fetal pelvis shows iliac wing (arrow) causing shadowing (star), which makes assessment of intrapelvic extent of tumor difficult. Fetal bladder is not seen. T = cephalic tip of tumor, Ab = fetal abdomen.

 


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  		Fig. 1B. —Female fetus at 32 weeks' gestational age with type III sacrococcygeal teratoma. Coronal T2-weighted turbo spin-echo MR image at 0.5 T (TR/TE, 8540/140) shows intrapelvic part of tumor (arrowheads).

 


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  		Fig. 1C. —Female fetus at 32 weeks' gestational age with type III sacrococcygeal teratoma. Sagittal T2-weighted turbo spin-echo MR image at 0.5 T (8540/140) shows tumor (arrowheads) displacing fetal bladder (B) upwards. Note mild hydronephrosis (arrow).

 


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  		Fig. 2A. —Female fetus at 32 weeks' gestational age with type II sacrococcygeal teratoma. Transverse sonogram through part of tumor external to fetus (6 cm between crosses) shows echogenic tumoral content that was mistaken for solid-type sacrococcygeal teratoma.

 


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  		Fig. 2B. —Female fetus at 32 weeks' gestational age with type II sacrococcygeal teratoma. Coronal T2-weighted turbo spin-echo MR image at 0.5 T (TR/TE, 9880/130) shows that tumor (arrowheads) has diffuse micro- and macrocystic content. Note mild urinary tract dilatation (arrow).

 


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  		Fig. 2C. —Female fetus at 32 weeks' gestational age with type II sacrococcygeal teratoma. Neonatal coronal T2-weighted MR image at 0.5 T (3500/600) confirms micro- and macrocystic content of tumor (arrowheads). Urinary tract dilatation (arrow) has increased.

 


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  		Fig. 3. —Male fetus at 29 weeks' gestational age has type II sacrococcygeal teratoma with intraspinal extension. Sagittal T2-weighted turbo spin-echo MR image at 1.5 T (TE, 87) shows completely cystic tumor (T). Intraspinal extension that was found at surgery is visualized on this image retrospectively (arrow). Note that fetal bladder (B) is displaced upwards.

 


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  		Fig. 4A. —Female fetus at 36 weeks' gestational age with type II sacrococcygeal teratoma and intraspinal extent. Transverse T2-weighted turbo spin-echo MR image at 0.5 T (TR/TE, 8670/140) through fetal buttocks shows cystic tumor (T) with lobulated posterior margins (arrowheads). Note partial volume artifact (arrow).

 


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  		Fig. 4B. —Female fetus at 36 weeks' gestational age with type II sacrococcygeal teratoma and intraspinal extent. Transverse T2-weighted turbo spin-echo MR image at 0.5 T (8670/140) obtained 1.5 cm cephalic to A shows intraspinal extent (arrowheads) of tumor (T). Note partial volume artifact (arrow).

 


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  		Fig. 4C. —Female fetus at 36 weeks' gestational age with type II sacrococcygeal teratoma and intraspinal extent. Neonatal sagittal T1-weighted turbo spin-echo MR image at 0.5 T (3500/650) confirms intraspinal extension (arrowheads) of tumor (T). Bladder (asterisk) is displaced upwards.

 


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  		Fig. 5. —Female fetus at 31 weeks' gestational age with solid type II sacrococcygeal teratoma. Sagittal T2-weighted turbo spin-echo MR image at 1.5 T (TE, 85) shows tumor (arrowheads) slightly heterogeneous and hyposignal compared with fetal bladder (asterisk) having intrapelvic extent (arrow).

 

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