Obstetric MRI

Abstract

Ultrasound is the imaging modality of choice for pregnant patients. However, MRI is increasingly utilized in patients in whom the sonographic diagnosis is unclear. These include maternal conditions unique to pregnancy such as ectopic pregnancy, placenta accreta, and uterine dehiscence. MRI is also being increasingly utilized in the assessment of abdominopelvic pain in pregnancy, in particular in assessment for appendicitis. Fetal MRI is performed to assess central nervous system (CNS) abnormalities and patients who are considering fetal surgery for conditions such as neural tube defects, congenital diaphragmatic hernia, and masses that obstruct the airway. In the future, functional MRI and fetal volumetry may provide additional information that can aid in our care of complicated pregnancies.

Fetal Cardiac Magnetic Resonance (CMR)

“…In contradistinction to US, MRI visualization of the fetus is not significantly limited by maternal obesity, fetal position, or oligohydramnios and visualization of the brain is not restricted by the ossified skull (Levine, 2006). MRI provides superior soft tissue contrast resolution and the ability to distinguish individual structures such as brain, lung, liver, kidney, and bowel.…”

“…If the mother does not tolerate the supine position, MRI should be performed in the left lateral decubitus. No special preparations, fasting, or sedation are required (Levine, 2006).…”

“…Development of fast MRI sequences significantly decreased motion artifacts and eliminated the need for fetal sedation (Levine, 2006).…”

“…The diagnosis of a congenital heart disease in a fetus should include prompt evaluation for associated non cardiac malformations and diagnosis of genetic syndromes (Carvalho et al, 2002). In-utero MRI can depict extracardiac anatomy and abnormalities of fetal brain, spine, lungs, liver, spleen, kidneys, and gastro-intestinal tract (Frates et al, 2004;Levine, 2006, Saleem et al, 2009). In our series, fetal MRI detected extracardiac abnormalities in association with cardiac structural abnormalities that helped in prenatal diagnosis of fetal syndromes.…”

“…Role of CMR includes anatomic and functional assessment of the cardiovascular system (Finn et al, 2006). Fetal MRI proved valuable in defining the details of fetal anatomy especially the central nervous system (Frates et al, 2004;Levine, 2006;Saleem et al, 2009) and potentially the heart (Gorincour et al, 2007;Saleem, 2008). However, CMR has not been thoroughly investigated in-utero.…”