Magnetic resonance imaging of the fetal musculoskeletal system

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FETAL IMAGING

Magnetic resonance imaging of the fetal musculoskeletal system Nancy A. Chauvin 1

&

Teresa Victoria 2 & Asef Khwaja 2 & Hisham Dahmoush 3 & Diego Jaramillo 4

Received: 4 May 2020 / Revised: 29 May 2020 / Accepted: 1 July 2020 / Published online: 19 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020

Abstract Diagnosing musculoskeletal pathology requires understanding of the normal embryological development. Intrinsic errors of skeletal development are individually rare but are of paramount clinical importance because anomalies can greatly impact patients’ lives. An accurate assessment of the fetal musculoskeletal system must be performed to provide optimal genetic counseling as well as to drive therapeutic management. This manuscript reviews the embryology of skeletal development and the appearance of the maturing musculoskeletal system on fetal MRI. In addition, it presents a comprehensive review of musculoskeletal fetal pathology along with postnatal imaging. Keywords Bone . Development . Fetus . Magnetic resonance imaging . Musculoskeletal . Skeleton

Introduction Diagnosing fetal musculoskeletal pathology requires understanding normal embryological development. An accurate assessment of the fetal musculoskeletal system must be performed to properly provide optimal genetic counseling and prognostication and to drive therapeutic management [1]. MRI of the fetal musculoskeletal system is considered complementary to US because MRI can confirm abnormalities and provide adjunct information for the fetal surgeon as well as the

Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00247-020-04769-z) contains supplementary material, which is available to authorized users. * Nancy A. Chauvin [email protected] 1

Department of Radiology, Hershey Children’s Hospital, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, USA

2

Department of Radiology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

3

Department of Radiology, Lucile Packard Children’s Hospital, Stanford University, Stanford, CA, USA

4

Department of Radiology, Columbia University Medical Center, New York, NY, USA

orthopedic surgeon to aid in surgical planning both prenatally and postnatally [2, 3].

Fetal musculoskeletal development The fetal skeleton develops from primitive mesenchymal cells that are precursors of membranous bone or cartilage. The facial bones, cranium and clavicles develop by intramembranous ossification in which the mesenchymal cells differentiate directly into osteocytes. The skull base, long or tubular bones, pelvis and the vertebral column develop via endochondral ossification in which a cartilaginous model is gradually replaced by bone [4]. Cartilage is identified by 5 weeks of gestation, and by 8 weeks gestation, a complete cartilaginous scaffold is present. In endochondral ossification