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Diagnosis and Characterization of Fetal Sacrococcygeal Teratoma with Prenatal MRI

Enrico Danzer1, Anne M. Hubbard2, Holly L. Hedrick1, Mark P. Johnson1, R. Douglas Wilson1, Lori J. Howell1, Alan W. Flake1 and N. Scott Adzick1

1 The Center for Fetal Diagnosis and Treatment, Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399.
2 University of Nebraska Medical Center, 981045 Nebraska Medical Center, Omaha, NE 68199-1045.


Figure 1
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  		Fig. 1 —26-weeks' gestation fetus with type I sacrococcygeal teratoma. Sagittal T2-weighted images show mixed solid and cystic lesion (arrowheads) arising from coccyx (double-headed arrow). No intrapelvic extension of tumor is seen. Urinary bladder (small arrow) is in normal position.

 

Figure 2
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  		Fig. 2 —22-weeks' gestation fetus with type II sacrococcygeal teratoma. Sagittal T2-weighted image shows large septate cystic mass (arrowheads) arising from coccyx (double-headed arrow) with small intrapelvic component. Urinary bladder (small arrow) is not displaced.

 

Figure 3
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  		Fig. 3A —29-weeks' gestation fetus with type III sacrococcygeal teratoma. Sagittal T2-weighted image shows oligohydramnios. Large mixed signal intensity is seen with predominately solid mass (arrowheads) extending into abdomen up to L3 level. Image shows superior and anterior displacement of urinary bladder (small arrow) and dilated fluid-filled vagina (large arrow) and uterus (double-headed arrow). Moderate ascites are seen.

 

Figure 4
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  		Fig. 3B —29-weeks' gestation fetus with type III sacrococcygeal teratoma. Coronal T2-weighted image shows small lungs (double-headed arrow) and dilation of renal collecting systems (small arrows). Renal cortex is heterogeneous with small cyst (arrowheads) present, which is consistent with renal dysplasia.

 

Figure 5
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  		Fig. 3C —29-weeks' gestation fetus with type III sacrococcygeal teratoma. Sagittal T1-weighted gradient-echo image shows displacement of high-intensity meconium-filled colon (arrowheads) by pelvic and abdominal mass (large arrows). Dilated fluid-filled vagina (double-headed arrow) and superior displacement of high-signal-intensity liver (small arrow) are seen.

 

Figure 6
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  		Fig. 4A —22-weeks' gestation fetus with sacrococcygeal teratoma. Oligohydramnios is seen. Image shows large, predominately solid, external mass (arrowheads) with large intrapelvic and intraabdominal component. Erosion of lower sacral spine (small arrow) and massive abdominal ascites are shown. Thoracic cavity is small (double-headed arrow). Severe skin and scalp edema (broad arrow) are consistent with hydrops.

 

Figure 7
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  		Fig. 4B —22-weeks' gestation fetus with sacrococcygeal teratoma. Sagittal T2-weighted image through maternal uterus shows marked heterogeneity and enlargement of placenta (arrowheads) measuring 6 cm at greatest width. Next to placenta is extrapelvic portion of sacrococcygeal teratoma (double-headed arrow).

 

Figure 8
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  		Fig. 5A —20-weeks' gestation fetus with sacrococcygeal teratoma type II. Sagittal T2-weighted image shows mixed solid and cystic mass (arrowheads) arising from coccyx. Intrapelvic extension (small arrow) with anterior displacement of low-signal-intensity meconium-filled colon (double-headed arrow) is seen.

 

Figure 9
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  		Fig. 5B —20-weeks' gestation fetus with sacrococcygeal teratoma type II. Sagittal T2-weighted image shows external mass (arrowheads). Dysplastic changes in renal cortex with multiple peripheral cortical cysts (double-headed arrow) are evident. No significant dilation of this renal collecting system is seen.

 

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