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Fetal MR How I do it in clinical practice M J Weston Leeds

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Page 1: Fetal MR How I do it in clinical practice

Fetal MR How I do it in clinical practice

M J WestonLeeds

Page 2: Fetal MR How I do it in clinical practice

Why do it?• Add diagnostic certainty to US findings

• Find additional anomalies

• Research

Page 3: Fetal MR How I do it in clinical practice

How is it done?

• Trickier than you think.• Fast acquisition times• Signal to noise problems• Risk to fetus

• T2 is mainstay• T1 useful for bowel and looking for fat or

haemorrhage

Page 4: Fetal MR How I do it in clinical practice

Cerebral MRI

T2 weighted

Page 5: Fetal MR How I do it in clinical practice

Other sequences

T2 T1 DWI

Page 6: Fetal MR How I do it in clinical practice

Change with time

24 weeks 36 weeks

Page 7: Fetal MR How I do it in clinical practice
Page 8: Fetal MR How I do it in clinical practice
Page 9: Fetal MR How I do it in clinical practice

Spina bifida

• MR is not a screening test

• All cases detected by US

• Confirmatory

• Assignment of level

• Visually very powerful for parents

Page 10: Fetal MR How I do it in clinical practice

Spinal cord

Conus Medullaris

Page 11: Fetal MR How I do it in clinical practice

Spina bifida

Page 12: Fetal MR How I do it in clinical practice
Page 13: Fetal MR How I do it in clinical practice

Head signs

Page 14: Fetal MR How I do it in clinical practice

Spina bifida

Page 15: Fetal MR How I do it in clinical practice

Sagittal

Aaronson OS et al. Radiology 2003; 227: 839‐843

US and MR are equally accurate at assigning level of lesion

Page 16: Fetal MR How I do it in clinical practice
Page 17: Fetal MR How I do it in clinical practice
Page 18: Fetal MR How I do it in clinical practice

Diastematomyelia

Page 19: Fetal MR How I do it in clinical practice

Split cord

Page 20: Fetal MR How I do it in clinical practice

Huge NTD on US

Page 21: Fetal MR How I do it in clinical practice

Visual impact of MRI

Page 22: Fetal MR How I do it in clinical practice
Page 23: Fetal MR How I do it in clinical practice

Caudal Regression Syndrome

Page 24: Fetal MR How I do it in clinical practice

Caudal regression

Page 25: Fetal MR How I do it in clinical practice

Head anomalies

• Commonest indication– Apparently isolated ventriculomegaly

• Establishing normal brain maturation

• Problems with counselling…

Page 26: Fetal MR How I do it in clinical practice

Unilateral hydrocephalus?• Near field reverberation

Page 27: Fetal MR How I do it in clinical practice

Hydrocephalus

Page 28: Fetal MR How I do it in clinical practice

Prognosis?

Page 29: Fetal MR How I do it in clinical practice

Ventricular bleed

Page 30: Fetal MR How I do it in clinical practice

Different sequences in bleed

Page 31: Fetal MR How I do it in clinical practice

But, postnatally…

Page 32: Fetal MR How I do it in clinical practice
Page 33: Fetal MR How I do it in clinical practice

Ultrasound Obstet Gynecol 2008; 32: 188 – 198Good prognosis…

Page 34: Fetal MR How I do it in clinical practice

Schizencephaly

Page 35: Fetal MR How I do it in clinical practice

Artefact or schizencephaly?

Page 36: Fetal MR How I do it in clinical practice

Follow-up

Deep asymmetrical calcarine sulcus

Page 37: Fetal MR How I do it in clinical practice

Arachnoid cyst

Taiwan J Obstet Gynecol 2007; 46: 187

Page 38: Fetal MR How I do it in clinical practice

Prepontine arachnoid cyst

Page 39: Fetal MR How I do it in clinical practice

Death of co-twin

Obstet Gynecol 2011; 118: 928 – 940

Monochorionic – neurodevelopmental delay 26% of survivorsDichorionic ‐ 2%

Page 40: Fetal MR How I do it in clinical practice

2 weeks later

Page 41: Fetal MR How I do it in clinical practice

Microcephaly etc

Page 42: Fetal MR How I do it in clinical practice

Face and holoprosencephaly

Page 43: Fetal MR How I do it in clinical practice

Face and head

Page 44: Fetal MR How I do it in clinical practice

Facial cleft and no eyes

Normal

Page 45: Fetal MR How I do it in clinical practice

Sent for head but…

Page 46: Fetal MR How I do it in clinical practice

But also has small lungs

Page 47: Fetal MR How I do it in clinical practice

Problem solving

Page 48: Fetal MR How I do it in clinical practice

Fetal kidneys

Page 49: Fetal MR How I do it in clinical practice
Page 50: Fetal MR How I do it in clinical practice

Inclusion cyst

Page 51: Fetal MR How I do it in clinical practice

Cervical teratoma

Page 52: Fetal MR How I do it in clinical practice

Neck lymphangioma

Page 53: Fetal MR How I do it in clinical practice

Nasopharyngeal teratoma?

Page 54: Fetal MR How I do it in clinical practice

Focal bulge

Page 55: Fetal MR How I do it in clinical practice

What is this?

Page 56: Fetal MR How I do it in clinical practice

Co‐existant Mole

Page 57: Fetal MR How I do it in clinical practice

Retroplacental bleed

Page 58: Fetal MR How I do it in clinical practice

Intrapartum scar rupture

Page 59: Fetal MR How I do it in clinical practice

Conclusions

• Complimentary to US

• Added worth is less if expert US

• Prognostic difficulties

• Changing the role of the Radiologist


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