FETAL MRI

an approach
to practice
Yarmaniani M Muchtar, MD
Ido N. Bramantya, MD

Department of Radiology
PRINCIPLES OF IMAGING DURING PREGNANCY
• Avoid ionizing radiation (IR) (X-ray; CT)
• US  modality of choice
• MRI  adjunct diagnostic test for fetal abN
 interpretation  clinical history & US
PRENATAL US LIMITATIONS
• Large maternal body habitus
• Abdominal scars  decrease US beam penetration
• Fetal lie
• Oligohydramnios
• Small FOV
• Limited resolution (relative)
WHEN TO PERFORM MRI
• Valid medical reason
• Only in select circumstances for screening
• US limitations  inconclusive

ACR-SPR Practice Parameter For The Safe And Optimal Performance OF

Fetal Magnetic Resonance Imaging (MRI) (Resolution 11; Revised 2015)
IS MRI SAFE IN PREGNANCY?
• No effect on embryogenesis
• No effect / risk to fetal hearing (Reeves et al 2010, Strizek et al 2015)
• Not known significant side effects
• Accepted at any stage of pregnancy
• Informed consent
The safety committee of the society of MRI 1991
Clements H et al, 2000. Kok RD et al, 2004; white paper (Kanal et al, 2002)
ACR & SPR, 2012 (revised 2015)
 COMFORT IS KING
Stacey Goergen. Obstetric MR. Melbourne 2017
CHALLENGES AND SOLUTIONS
• Fetal motion. We avoid maternal sedation
 Solution: ultrafast MRI sequences
• Small-sized developing structures
 Solution: advances MRI surface coils & gradients
CHALLENGES AND SOLUTIONS
• 3T Machine: Artifacts, SNR, SAR
 Solution: technical, patient screening
• Peri-procedural ethics
• Communicating with pts
• Don’t give results independently to pts
• Discuss with FM Obgyn, Neurosurgeon, etc
WHO?? WHERE??
• MR technologist & attending radiologist 
familiar with fetal MR procedure & diagnosis
• Preferred in 1,5 T MR machine
• We used 3 T MR machine
FETAL MRI INDICATIONS
FETAL ORGANS Indications
Brain Congenital anomalies, vascular
abnormalities

Spine NTD, etc

Head and Neck Mass, airways obstruction
Thorax Congenital lung malformation, CDH,
mass, lung volumetry; assessment
of esophageal atresia

Abdomen & Pelvis Mass, GU anomatlies, renal

anomalies, bowel anomalies

Twins Complications of MCT

Fetal surgery planning Assessment

ACR-SPR Practice Parameter For The Safe And Optimal Performance OF Fetal Magnetic Resonance
Imaging (MRI) (Resolution 11; Revised 2015)
FETAL MRI: a screening tool
In a study of 66 fetuses at high risk for brain
anomaliles (16WG and above), fetal MRI changed
US diagnosis in 40%, changed counseling in 55%,
and management in 46%

Saleem SN, et al. The impact of fetal MRI findings on counseling and management
in high risk pregnancies for brain malformations. EJRNM 2008; 1(2):20-25
 RSAB HK: our almost-one-year experience 
8
7 44 FETAL MRI(s)
6
5
4
3
2
1
0
Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
ANOMALIES (WE HAVE) DETECTED
BRAIN: anencephaly, microcephaly, cephalocele,
porenchepalic cyst, ventriculomegaly, intraventricular
bleeding, dysgenesis corpus callosum, megasisterna
magna, etc
SPINE: spinal dysraphism
THORACIC: CPAM, CDH
ANOMALIES (WE HAVE) DETECTED
ABDOMEN : esophageal atresia w/w.o. fistula,
duodenal atresia, gastroschizis, cloacal malformation,
renal agenesis, MDK, ARPKD
MSK : skeletal dysplasia
TWINS : complications
FETAL BRAIN: normal & abnormal
• Sulci – Gyri
• Midline structures & CC
• Ventriculomegaly
• Parenchymal lesions
• Posterior fossa
• Complex anomalies
 NORMAL FETAL BRAIN

ABNORMAL FETAL BRAIN

FETAL HEAD & NECK
• Neck mass
• Cyst / Solid
• Extension
• Airways obstruction
• Neck masses or encephalocele?
 FETAL HEAD & NECK MASSES

INTRA-ORAL TUMOR LYMPHATIC MALFORMATION

Obstetric MR. Melbourne 2017 THYMIC CYST GOITER

FETAL LUNG
• Lung volume and maturity
• Mediastinal & Diafragm
• Masses: MRI differentiates between congenital masses
as most have characteristic MRI appearance
• CPAM Pulmonary sequestration
• CDH Pleural effusion
 NORMAL FETAL LUNG

Cassidy. Obstetric MR. Melbourne 2017

NORMAL FETAL LUNG
 FETAL LUNG: CPAM

32W GA; type 1 CPAM

One week post-natal chest CT

Pathology specimen
in concordance
with type 1 CPAM
FETAL THORAX: CDH
• US: lung tumor?  MRI conclude as CDH
• MRI differentiate between lung mass and CDH
• Characteristic appearance of viscera & bowel
G1P0A0, 37W, SUSP. CDH
FETAL ABDOMEN-PELVIS
• Intestinal obstruction
• Complex genital anomalies, fetal syndrome
• US: intestinal obstruction? Biliary cyst?
• MRI conclude the diagnosis
Esophageal atresia
Intestinal atresia,
gastroschizis,
Meconium
peritonitis, ascites
 G5P3A1, 31W, GASTRIC-DUODENAL OBSTRUCTION

USG: suspected for UVJ obstruction. MRI: Cloacal malformation, hydrocolpos,

hidronephrosis, hidroureter. Confirmed by post natal genitography.
 G1P0A0, 33W, CLOACAL MALFORMATION

USG: suspected for UVJ obstruction. MRI: Cloacal malformation, hydrocolpos,

hidronephrosis, hidroureter. Confirmed by post natal genitography.
 MRI TWIN PREGNANCY
• Complicated twins pregnancy

http://radnet.bidmc.harvard.edu/fetalatlas/gestations/demise/demise.html
WOMEN’S IMAGING: GYNECOLOGIC CASES
• Deep Infiltrating Endomeriosis
• Placental Adhesive Disorders
• Malignancies
DEEP INFILTRATING ENDOMETRIOSIS

endometriosis infiltrating the rectum and bladder

DEEP INFILTRATING ENDOMETRIOSIS

Rectal Endometriosis
PAD EVALUATION
PREGNANCY WITH MALIGNANCY
THANK YOU