Ultrasonic and magnetic resonance imaging of fetal sacrococcygeal teratoma

Kirkinen, Pertti; Partanen, Kaarina; Merikanto, Juhani; Ryynänen, Markku; Haring, P; Heinonen, Kirsti

doi:10.3109/00016349709034902

Cited by 64 publications

(30 citation statements)

References 15 publications

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“…magnetic resonance imaging (MRI), have been described and several studies have been performed to define the prognostic value of these techniques. Kirkinen et al [26] noted that prenatal MRI was helpful in the accurate definition of the intrapelvic extension of the SCT. The assessment of the extrapelvic tumor, including vascularity and differentiation of the tumor type was, however, not aided by this imaging modality.…”

Section: Diagnosismentioning

confidence: 99%

Sonographic Prognostic Factors in Prenatal Diagnosis of SCT

Neubert¹,

Trautmann²,

Berno³

et al. 2004

Fetal Diagn Ther

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Objective: A subset of fetuses with sacrococcygeal teratomas (SCT) develops hydrops caused by high-output heart failure. Identification of fetuses at risk for hydrops is important because surgical intervention may reverse the pathophysiology of the disease. The aim of this study was to evaluate sonographic prognostic factors regarding tumor morphology and vascularity associated with the development of hydrops in utero. Methods: Over a 10-year period, we identified 7 fetuses with SCT diagnosed antenatally and managed at the University of Mainz. We retrospectively reviewed the charts of mothers and infants and recorded data on prenatal diagnosis, tumor size and localization, perinatal management, neonatal care, and fetal outcome. Results: The diagnosis of SCT was made in all cases by ultrasound. The median gestational age at the time of initial diagnosis was 23 weeks. In 3 cases, signs of fetal heart failure were detected by ultrasound. Pathological blood flow in the venous system was further noted in 2 cases. One fetus developed hydrops. The mean gestational age at delivery was 35 weeks, depending on the presence or absence of maternal or fetal complications. Six infants were delivered by cesarean section, and 1 by vaginal delivery. After fetal stabilization, surgery was performed in 5 of 7 cases. Inadequate ventilation secondary to prematurity was a contributing factor to death in 1 fetus. One fetal intrauterine death occurred at 27 weeks of gestation. Conclusion: Pregnancies with antenatally diagnosed fetal SCT necessitate frequent monitoring to ensure the detection of fetal/maternal complications by ultrasound and Doppler ultrasound. The most important prognostic criteria were cardiomegaly, fetal hydrops, and increased preload indexes of the fetal venous system as sign of fetal heart failure. Many studies show that the occurrence of pulsations in the umbilical vein of a hydropic fetus correlates with a poor fetal outcome. The decision on the optimal time of delivery should therefore be made by a multidisciplinary team of specialists.

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Section: Diagnosismentioning

confidence: 99%

Sonographic Prognostic Factors in Prenatal Diagnosis of SCT

Neubert¹,

Trautmann²,

Berno³

et al. 2004

Fetal Diagn Ther

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“…This information is important, since it will affect the postnatal surgical approach to the lesion (101). Fetal MR imaging has been shown to be useful for planning postpartum surgery (86,97,99,101), and for decision-making regarding the timing and mode of delivery (101).…”

Section: Non-cns Anomaliesmentioning

confidence: 99%

Obstetric MRI

Levine

2006

Magnetic Resonance Imaging

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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.

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“…It is important to note that although the pelvic extension of the tumor was sonographically detected before surgery, it was grossly underestimated. Kirkinen et al [14] reported that ultrasound examination alone, unlike MRI, was not able to reliably discern the intrapelvic extent of an SCT due to acoustic shadowing by the fetal pelvic bones. Fast spin MRI may be helpful for more accurate preoperative assessment since it enables sufficient outlining of the intrapelvic structures without fetal movement artifacts.…”

Section: Discussionmentioning

confidence: 99%

In utero Repair of Rectal Atresia after Complete Resection of a Sacrococcygeal Teratoma

Chiba

Albanese²,

Jennings³

et al. 2000

Fetal Diagn Ther

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Purpose: A case of a fetus with a prenatally diagnosed sacrococcygeal teratoma that produced high-output cardiac failure, hydrops, rectal atresia, and urinary tract obstruction is presented. The unique prenatal surgical management along with the embryogenesis of tumor-related rectal atresia is discussed. Case Report: A large fetal sacrococcygeal teratoma with a significant intrapelvic component was detected at routine ultrasound in a 35-year-old gravida 3 para 2. Fetal hydrops developed rapidly due to high-output cardiac failure from the vascular ‘steal’ by the growing tumor. The urinary tract was obstructed due to the intrapelvic tumors mass. At 27 weeks’ gestation, the female fetus underwent hysterotomy, resection of the entire mass and urinary diversion via bilateral flank ureterostomies. The rectum was found to be completely atretic due to apparent encasement by the tumor. Pull-through anorectoplasty was carried out concurrently. At 30 weeks’ gestation, the mother developed preterm labor and a 1.8-kg was delivered by cesarean section. The baby did very well for 3 days but had a cardiac arrest and died due to an atrial perforation by a transfemoral venous catheter. Conclusions: To our knowledge this is the first report of a complete prenatal resection of a sacrococcygeal teratoma with concomitant pull-through anorectoplasty for rectal atresia.

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Ultrasonic and magnetic resonance imaging of fetal sacrococcygeal teratoma

Abstract: Antepartal MRI is useful for examination of fetal SCT, but reliable differentiation of mature and immature SCT is not possible antepartally.

Cited by 64 publications

References 15 publications

Sonographic Prognostic Factors in Prenatal Diagnosis of SCT

Sonographic Prognostic Factors in Prenatal Diagnosis of SCT

Obstetric MRI

In utero Repair of Rectal Atresia after Complete Resection of a Sacrococcygeal Teratoma

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