Magnetic resonance imaging of the fetal gastrointestinal system
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FETAL IMAGING
Magnetic resonance imaging of the fetal gastrointestinal system Megan B. Marine 1 & Monica M. Forbes-Amrhein 1 Received: 27 November 2019 / Revised: 2 March 2020 / Accepted: 6 April 2020 / Published online: 19 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract In this paper the authors review the normal imaging appearance of the fetal gastrointestinal tract and patterns of fetal gastrointestinal tract obstruction. The authors include a detailed summary from esophagus to the rectum, including the expected pattern of meconium and small-bowel contents at different gestational ages. Common fetal gastrointestinal tract obstructions are reviewed with accompanying case examples, emphasizing the role of the meconium and bowel-caliber patterns in establishing differential diagnoses. This review also includes imaging pitfalls, complications of gastrointestinal tract obstruction, and implications for patient care. Keywords Abdomen . Bowel obstruction . Fetus . Gastrointestinal tract . Magnetic resonance imaging . Meconium
Introduction Fetal MRI is particularly useful in cases of bowel obstruction identified on the fetal US examination. The large field of view of MRI allows for visualization of the extent and pattern of dilated bowel loops. Importantly, meconium is T1 hyperintense, allowing T1 sequences to serve as a “fetal enema.” This fetal enema allows for visualization and identification of the location of the meconium as well as the caliber of the colon, information that can narrow the differential diagnosis in a gastrointestinal tract obstruction. Recognition of the normal MRI appearance of the gastrointestinal tract, including the meconium patterns, at every gestational age allows for identification and accurate diagnosis of abnormalities. The diagnosis can impact parent counseling, delivery planning, postnatal care plan, preoperative planning and patient outcomes.
Normal appearance of the fetal gastrointestinal tract The digestive tract begins to develop in the third week of gestation and is complete by the early to mid-second trimester
* Megan B. Marine [email protected] 1
Department of Radiology and Imaging Sciences Indiana University School of Medicine, Riley Hospital for Children, 705 Riley Hospital Drive, Room 1053, Indianapolis, IN 46202, USA
[1]. The anterior gut forms the pharyngeal membrane through the second part of the duodenum. The midgut forms the duodenum distal to the bile duct through the distal third of the transverse colon. This portion of the bowel develops outside the peritoneal cavity during the 6th–10th gestational weeks. The hindgut forms the left colon to the rectum [1].
Esophagus and stomach The esophagus appears as a column of T2 hyperintensity extending from the pharynx to the stomach if imaged during a fetal swallow, which begins to occur at approximately 14 weeks of gestation [2]. When imaging is not obtained during a swallow, the esophagus will not be distended with fluid and thus not well seen. Therefore, non- or partial visualization
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