The use of magnetic resonance imaging for the diagnosis of fetal intracranial anomalies

Abstract

While fetal cranial sonography has been used for the sensitive detection of ventriculomegaly, ancillary imaging techniques may be needed for precise delineation of structural abnormalities. This report outlines the radiologic and clinical results using maternal magnetic resonance imaging (MRI) in ten patients with suspected fetal intracranial anomalies. Imaging was accomplished at 17-39 weeks gestational age, using spin-echo, a multislice technique with intramuscular morphine sulfate for sedation. In four cases, MRI significantly clarified the sonographic diagnosis, while in two cases the scan agreed with the sonographic findings. In one patient, MRI failed to image a lumbar meningomyelocele associated with the Chiari II malformation. In two patients with the Chiari II malformation, both sonography and MRI failed to delineate the anatomic pathology completely. Optimal imaging resolution was achieved in the third trimester. Four patients died in the perinatal period. All the surviving patients required shunting to treat intracranial hypertension: only two patients were meeting cognitive milestones. We conclude that due to the high incidence of multiple anomalies in the fetus with ventriculomegaly, precision in neuroradiological diagnosis is essential. MRI can be a useful adjunct to cranial sonography for the specific delineation of abnormalities of the fetal central nervous system.