MRI of Fetal Genitourinary Anomalies
Jacqueline T. Caire1,
Ronald M. Ramus2,
Kevin P. Magee2,
Bryan K. Fullington1,
David H. Ewalt3 and
Diane M. Twickler1,2
1 Department of Radiology, University of Texas Southwestern Medical Center, 5323
Harry Hines Blvd., Dallas, TX 75390-8896.
2 Department of Obstetrics and Gynecology, University of Texas Southwestern
Medical Center, Dallas, TX 75390-8896.
3 Perinatal Associates of Texas, Ste. 205, 8315 Walnut Hill Ln., Dallas, TX
75230-5104.
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Fig. 1A. —35-gestational-week-old fetus with suspected renal agenesis,
which occurs if metanephric diverticulum fails to develop or to penetrate
metanephric blastema. Coronal MRI obtained through fetus shows bright fluid in
stomach (white arrow) and psoas muscles (black arrows), but
no kidneys are identified.
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Fig. 1B. —35-gestational-week-old fetus with suspected renal agenesis,
which occurs if metanephric diverticulum fails to develop or to penetrate
metanephric blastema. Axial MRI of fetal abdomen reveals large anterior mass
thought to represent single abnormal lower extremity (large straight
arrow), but no kidneys, on either side of spinal column (small
straight arrow). Placenta (curved arrows) abuts fetus because of
anhydramnios.
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Fig. 1C. —35-gestational-week-old fetus with suspected renal agenesis,
which occurs if metanephric diverticulum fails to develop or to penetrate
metanephric blastema. Photograph of stillborn neonate displays appearance of
sirenomelia.
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Fig. 2. —Cystic areas (arrows) are bright on coronal
T2-weighted image of 31-gestational-week-old fetus with bilateral multicystic
dysplastic kidneys.
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Fig. 3. —T2-weighted image obtained with single-shot fast spin-echo
sequence in 25-gestational-week-old fetus with left ureteropelvic junction
obstruction and retroperitoneal urinoma. Urine and urinoma appear bright.
Dilated left renal pelvis (arrows) is shown in axial plane, deviated
to midline by large urinoma (u).
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Fig. 4A. —30-gestational-week-old female fetus with duplicated right
collecting system, which is caused by second ureteral bud arising from
mesonephric duct. Coronal MRI obtained through fetus reveals that upper moiety
of pole is dilated on right (thin white arrows), whereas lower moiety
of right kidney pole displays mild dilatation of renal pelvis (thick white
arrow). Left kidney appears normal (black arrow).
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Fig. 4B. —30-gestational-week-old female fetus with duplicated right
collecting system, which is caused by second ureteral bud arising from
mesonephric duct. Sagittal MRI of perineum of fetus shows dilated ureterocele
in region of vagina (arrow) with associated ureteral dilatation
(arrowheads).
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Fig. 4C. —30-gestational-week-old female fetus with duplicated right
collecting system, which is caused by second ureteral bud arising from
mesonephric duct. Axial MRI obtained at level of perineum shows vaginal
ectopic ureterocele (large arrow) and thighs (small arrows)
anteriorly.
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Fig. 4D. —30-gestational-week-old female fetus with duplicated right
collecting system, which is caused by second ureteral bud arising from
mesonephric duct. Photograph shows neonate's external perineum with
ureterocele (arrows) pulled inferiorly by surgeon as well as
relationship of ureterocele to vaginal walls.
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Fig. 5A. —MRI of megacystis-microcolon–intestinal hypoperistalsis
syndrome in 30-gestational-week-old female fetus. b = bladder. Sagittal MRI
obtained through fetal abdomen and pelvis reveals massively dilated bladder
and renal hydronephrosis (arrow).
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Fig. 5B. —MRI of megacystis-microcolon–intestinal hypoperistalsis
syndrome in 30-gestational-week-old female fetus. b = bladder. Axial MRI
obtained through mid abdomen shows large bladder and bilateral hydronephrosis
(arrows).
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Fig. 6A. —34-gestational-week-old fetus with cloacal exstrophy. Axial
MRI obtained through fetal abdomen shows anterior omphalocele (long
arrows) and posterior myelocystocele (short arrow).
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Fig. 6B. —34-gestational-week-old fetus with cloacal exstrophy. Axial
MRI of perineal region shows hemibladders (arrows) and bladder
exstrophy. Anus is absent.
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Fig. 6C. —34-gestational-week-old fetus with cloacal exstrophy.
Sagittal MRI obtained through fetus shows extensive fetal malformations
including myelocystocele (black arrow), hemibladder (white open
arrow), and omphalocele (white solid arrows).
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Fig. 6D. —34-gestational-week-old fetus with cloacal exstrophy. Coronal
T2-weighted image of lumbosacral spine shows dilated distal spinal canal with
bright signal, suggestive of myelocystocele.
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Fig. 6E. —34-gestational-week-old fetus with cloacal exstrophy.
Photograph of lower abdomen of neonate reveals anterior open defect
(straight arrows) and hemibladder (curved arrows).
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Copyright © 2003 by the American Roentgen Ray Society.
