Prenatal Imaging Diagnosis of Suprarenal Lesions

Abstract

Introduction: Prenatal suprarenal lesions represent diverse pathologies. This study investigated prenatal imaging features and regression patterns associated with specific lesion diagnoses. Methods: This is a multicenter retrospective review of fetuses with prenatally diagnosed suprarenal lesions between 2001 and 2019. Prenatal ultrasound and MRI characteristics, postnatal imaging, and clinical course were reviewed. Prenatal imaging findings were compared by the most common diagnoses and regression patterns. Results: Forty-four fetuses were prenatally diagnosed with suprarenal lesions. Diagnoses included pulmonary sequestration (n = 12; 27.3%), adrenal hemorrhage (n = 12; 27.3%), upper quadrant cyst (including 2 duplication cysts, 1 splenic cyst, and 3 indeterminate cysts), neuroblastoma (n = 4), adrenal hyperplasia (n = 3), bilateral adrenal calcifications (n = 1), and indeterminate lesions (n = 6). Sequestrations were uniformly left-sided (100 vs. 50%; p = 0.014) and diagnosed earlier in gestation than adrenal hemorrhages (p = 0.025). Sequestrations were also significantly more likely to have a prenatal feeding vessel (p = 0.005), low T1 MRI signal (p = 0.015), and no MRI blood products (p = 0.018) compared to adrenal hemorrhages. When comparing all 44 patients, a prenatal feeding vessel and low T1 signal on prenatal MRI were significantly associated with lesion persistence (p = 0.003; p = 0.044). Discussion/Conclusion: Imaging findings on prenatal ultrasound and MRI aid in the diagnosis of suprarenal lesions, including differentiating pulmonary sequestrations and adrenal hemorrhages.

The Clinical Value of Prenatal Ultrasonography in the Differential Diagnosis of Fetal Suprarenal Space-Occupying Lesions

“… 3 A combination of MRI and ultrasound graph would be helpful for diagnosis of suprarenal entity. 6 , 10 …”

“…Besides, non-surgical treatment was also proposed as a safe alternative for extra-pulmonary sequestration, 15 because several of these lesions might be invisible on imaging which could be categorized as postnatal regression. 6 Fetal neuroblastoma usually has a better prognosis when diagnosed early and may even disappear in utero or shortly after birth. However, in rare instances, neuroblastoma may metastasize to the liver.…”

“…1–3 Thus, early diagnosis is also particularly important for developing successful intervention programs and improving the prognosis of newborns. 5 , 6 …”

Prenatal presentation of an adrenocortical tumor

“…Depending on the case series, neuroblastoma and pulmonary sequestrations are the next most common etiologies. 2 , 3 , 4 , 5 Prenatal ultrasounds are the standard first mode of imaging. Fetal MRI has been utilized for follow‐up imaging, with one case series showing a 70% concordance rate between ultrasound and MRI.…”

“… 1 Most often, these masses are due to an adrenal hemorrhage although tumors and other etiologies occur as well. 2 , 3 , 4 , 5 Even though imaging may not confirm a definitive diagnosis, surgical intervention is not always required. Adrenocortical tumors are rare pediatric tumors and most patients present in early childhood with signs or symptoms of endocrinopathy.…”