How to read a fetal magnetic resonance image 101
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FETAL IMAGING
How to read a fetal magnetic resonance image 101 Ailish C. Coblentz 1 & Sara R. Teixeira 1 & David M. Mirsky 2 & Ann M. Johnson 1 & Tamara Feygin 1 & Teresa Victoria 1 Received: 21 April 2020 / Revised: 22 May 2020 / Accepted: 1 July 2020 / Published online: 19 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Accurate antenatal diagnosis is essential for planning appropriate pregnancy management and improving perinatal outcomes. The provision of information vital for prognostication is a crucial component of prenatal imaging, and this can be enhanced by the use of fetal MRI. Image acquisition, interpretation and reporting of a fetal MR study can be daunting to the individual who has encountered few or none of these examinations. This article provides the radiology trainee with a general approach to interpreting a fetal MRI. The authors review the added value of prenatal MRI in the overall assessment of fetal wellbeing, discuss MRI protocols and techniques, and review the normal appearance of maternal and fetal anatomy. The paper concludes with a sample template for structured reporting, to serve as a checklist and guideline for reporting radiologists. Keywords Fetus . Interpretation . Magnetic resonance imaging . Normal anatomy . Obstetrics
Introduction Accurate antenatal diagnosis is essential in planning appropriate pregnancy management and improving perinatal outcomes. While many prenatally diagnosed conditions can be managed conservatively, others require specialized planning for delivery and early postnatal management, or might be suitable for antenatal surgical intervention [1, 2]. Certain conditions remain universally fatal. Providing information vital for prognostication is a crucial component of prenatal imaging, and this can be enhanced by the use of fetal MRI. The Society for Pediatric Radiology provides the following indications for fetal MRI: (1) to provide adjuvant information when sonography is unable to clearly define an abnormality and more information is needed, for example in the setting of maternal obesity; (2) when MR-specific information is required to make decisions about care, for example, calculated lung volumes in cases of congenital diaphragmatic hernia; and
* Teresa Victoria [email protected] 1
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(3) when a fetus is at significant risk for an abnormality that might be sonographically occult, for example neurologic ischemia following laser ablation for twin–twin transfusion [3]. The optimal timing for performing MRI is dependent on the pathology suspected by sonography. Before 18 weeks, fetal organs are underdeveloped, movement is increased, and certain pathologies might not have developed [4, 5]. Although MRI can be performed at any gestational age, it is typically done after 20 weeks, to improve visualization of the fetal organs [5, 6]. It is judicious to expedite the MRI study when an abnormality is suspected sonographically, particularly in cases where the parents are considering termination. Fetal MRI interpretation is improv
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