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Supplemental Value of MRI in Fetal Abdominal Disease Detected on Prenatal Sonography: Preliminary Experience

¹ Department of Radiology, University of California San Francisco, 505 Parnassus Ave., Box 0628, M-372, San Francisco, CA, 94143–0628.
² Present address: Division of Health Sciences and Technology, Harvard Medical School–Massachusetts Institute of Technology, 260 Longwood Ave., Rm. 213, Boston, MA 02115.

View larger version (146K): [in a new window]   Fig. 1. —31-week fetus with congenital hemochromatosis. Coronal T2*-weighted MR image (TR/TE, 130/20; 20° flip angle) shows that fetal liver (black arrow) is of diffusely low T2* signal relative to maternal liver (white arrow), highly suggestive of congenital hemochromatosis. Diagnosis was confirmed postnatally.

View larger version (112K): [in a new window]   Fig. 2A. —28-week fetus with subdiaphragmatic sequestration. Coronal T2-weighted single-shot fast spin-echo MR image (TR/TE, infinite/96) shows 2.7-cm left subdiaphragmatic mass (arrow) of high T2 signal.

View larger version (118K): [in a new window]   Fig. 2B. —28-week fetus with subdiaphragmatic sequestration. Sagittal T2-weighted MR image shows mass (black arrow) above normal left kidney (white arrow). Fetal stomach (S) is filled with fluid. MRI diagnosis of subdiaphragmatic sequestration was confirmed at neonatal surgery.

View larger version (151K): [in a new window]   Fig. 3A. —23-week fetus with cecal atresia. Axial gray-scale sonogram shows hypoechoic mass (arrow) in fetal abdomen.

View larger version (104K): [in a new window]   Fig. 3B. —23-week fetus with cecal atresia. Coronal T1-weighted spoiled gradient-echo MR image (TR/TE, 140/4.2; 70° flip angle) shows intraabdominal mass (horizontal white arrow) containing high-T1-signal-intensity material closely associated with tubular structure (vertical white arrow) containing similar material.

View larger version (109K): [in a new window]   Fig. 3C. —23-week fetus with cecal atresia. Coronal T2-weighted single-shot fast spin-echo MR image (infinite/96) shows that same mass (arrow) contains material of low T2 signal intensity, consistent with meconium. Note normal bladder (B). Diagnosis of gastrointestinal anomaly was suggested on basis of MRI findings, and cecal atresia was confirmed at surgery.

View larger version (158K): [in a new window]   Fig. 4A. —20-week fetus with cystic abdominal mass. Axial T2-weighted single-shot fast spin-echo MR image (TR/TE, infinite/96) shows 5.5-cm multilocular cystic mass (asterisk) in fetal abdomen and normal kidneys (arrows).

View larger version (125K): [in a new window]   Fig. 4B. —20-week fetus with cystic abdominal mass. Sagittal T2-weighted MR image shows mass (asterisk), which was presumed to be mesenteric cyst. Follow-up imaging after birth failed to show mass, and no intervention was performed.

View larger version (143K): [in a new window]   Fig. 5A. —30-week fetus with exophytic hepatic hemangioma. Coronal gray-scale sonogram shows large hypoechoic heterogeneous mass (arrow) arising from left lobe of liver (L).

View larger version (151K): [in a new window]   Fig. 5B. —30-week fetus with exophytic hepatic hemangioma. Coronal power Doppler sonogram reveals multiple feeding vessels (arrow) emanating from liver.

View larger version (120K): [in a new window]   Fig. 5C. —30-week fetus with exophytic hepatic hemangioma. Coronal T1-weighted spoiled gradient-echo MR image (TR/TE, 140/4.2; 70° flip angle) shows large homogenous mass (asterisk) of moderate signal intensity in left upper quadrant.

View larger version (131K): [in a new window]   Fig. 5D. —30-week fetus with exophytic hepatic hemangioma. Coronal T2-weighted single-shot fast spin-echo MR image (infinite/96) shows heterogeneity within mass (asterisk), which appears to be adjacent to liver but is not clearly of hepatic origin.

View larger version (154K): [in a new window]   Fig. 6A. —Fetus with dilated ectopic ureter. Sagittal gray-scale sonogram obtained at 29 weeks' gestation shows two fluid-filled masses in abdomen and pelvis. Smaller structure (arrow) was correctly identified as fetal bladder, and larger structure (asterisk) was thought to represent either dilated ureter or seminal vesicle cyst.

View larger version (128K): [in a new window]   Fig. 6B. —Fetus with dilated ectopic ureter. Sagittal T2-weighted single-shot fast spin-echo MR image (TR/TE, infinite/96) obtained at 30 weeks' gestation shows two cystic fluid-filled masses in fetal pelvis. Anterior structure (arrow) was thought to be urachal diverticulum, whereas posterior structure (asterisk) was thought to represent bladder. At surgery, anterior mass was found to be bladder, and posterior mass was dilated distal ureter.

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