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Single-Shot Fast Spin-Echo MR Imaging of the Fetus: A Pictorial Essay¹

¹ From the Departments of Diagnostic Radiology (B.J.H., K.R.B., B.F.K.) and Obstetrics and Gynecology/Maternal and Fetal Medicine (K.D.R.), Mayo Clinic, 200 First St SW, Rochester, MN 55905. Presented as a scientific exhibit at the 1998 RSNA scientific assembly. Received February 9, 1999; revision requested May 20 and received June 29; accepted June 29. Address reprint requests to B.J.H.

View larger version (151K): [in a new window]   Figure 1a.   Normal CNS findings in a 20-week-old fetus. (a) Axial T2-weighted MR image of the head obtained early in gestational development shows a smooth cortical surface. The cerebrospinal fluid-filled lateral ventricles have high signal intensity. Three layers of the cerebrum are identified including the hypointense cortical gray matter (curved arrow), the hyperintense unmyelinated white matter, and the lower-signal-intensity germinal matrix (straight arrow). (b) Axial T2-weighted MR image shows the midbrain (straight arrow), developing cerebellum (arrowhead), and optic chiasm (curved arrow). (c) Axial T2-weighted MR image depicts the cerebellar hemispheres (arrowhead) and the orbits.

View larger version (158K): [in a new window]   Figure 1b.   Normal CNS findings in a 20-week-old fetus. (a) Axial T2-weighted MR image of the head obtained early in gestational development shows a smooth cortical surface. The cerebrospinal fluid-filled lateral ventricles have high signal intensity. Three layers of the cerebrum are identified including the hypointense cortical gray matter (curved arrow), the hyperintense unmyelinated white matter, and the lower-signal-intensity germinal matrix (straight arrow). (b) Axial T2-weighted MR image shows the midbrain (straight arrow), developing cerebellum (arrowhead), and optic chiasm (curved arrow). (c) Axial T2-weighted MR image depicts the cerebellar hemispheres (arrowhead) and the orbits.

View larger version (131K): [in a new window]   Figure 1c.   Normal CNS findings in a 20-week-old fetus. (a) Axial T2-weighted MR image of the head obtained early in gestational development shows a smooth cortical surface. The cerebrospinal fluid-filled lateral ventricles have high signal intensity. Three layers of the cerebrum are identified including the hypointense cortical gray matter (curved arrow), the hyperintense unmyelinated white matter, and the lower-signal-intensity germinal matrix (straight arrow). (b) Axial T2-weighted MR image shows the midbrain (straight arrow), developing cerebellum (arrowhead), and optic chiasm (curved arrow). (c) Axial T2-weighted MR image depicts the cerebellar hemispheres (arrowhead) and the orbits.

View larger version (170K): [in a new window]   Figures 2, 3.   (2) Normal CNS findings in a 29-week-old fetus. (a) Axial MR image shows developing cortical sulci and gyri, the posterior horns of the lateral ventricles (arrowhead), and the cavum septum pellucidum (arrow). With fetal maturation, the brain loses its smooth, lissencephalic contour and normal anatomy is more clearly defined. (b) Axial MR image obtained inferior to a shows the cerebellar hemispheres, midbrain (arrowhead), and optic chiasm (arrow). (3) Normal CNS findings in a 32-week-old fetus. Sagittal MR image demonstrates further development of the major cortical sulci and gyri. The cerebellum (arrowhead) and brain stem (arrow) are also visible. The midbrain, pons, medulla, and upper spinal cord are seen as separate structures.

View larger version (157K): [in a new window]   Figures 2, 3.   (2) Normal CNS findings in a 29-week-old fetus. (a) Axial MR image shows developing cortical sulci and gyri, the posterior horns of the lateral ventricles (arrowhead), and the cavum septum pellucidum (arrow). With fetal maturation, the brain loses its smooth, lissencephalic contour and normal anatomy is more clearly defined. (b) Axial MR image obtained inferior to a shows the cerebellar hemispheres, midbrain (arrowhead), and optic chiasm (arrow). (3) Normal CNS findings in a 32-week-old fetus. Sagittal MR image demonstrates further development of the major cortical sulci and gyri. The cerebellum (arrowhead) and brain stem (arrow) are also visible. The midbrain, pons, medulla, and upper spinal cord are seen as separate structures.

View larger version (167K): [in a new window]   Figures 2, 3.   (2) Normal CNS findings in a 29-week-old fetus. (a) Axial MR image shows developing cortical sulci and gyri, the posterior horns of the lateral ventricles (arrowhead), and the cavum septum pellucidum (arrow). With fetal maturation, the brain loses its smooth, lissencephalic contour and normal anatomy is more clearly defined. (b) Axial MR image obtained inferior to a shows the cerebellar hemispheres, midbrain (arrowhead), and optic chiasm (arrow). (3) Normal CNS findings in a 32-week-old fetus. Sagittal MR image demonstrates further development of the major cortical sulci and gyri. The cerebellum (arrowhead) and brain stem (arrow) are also visible. The midbrain, pons, medulla, and upper spinal cord are seen as separate structures.

View larger version (164K): [in a new window]   Figures 4, 5. (4) Normal non-CNS findings in a 27-week-old fetus. (a) Sagittal MR image shows various anatomic features highlighted by high-signal-intensity amniotic fluid, including the facial profile (straight solid arrow), the oropharynx (arrowhead), the foot (open arrow), and loops of the three-vessel umbilical cord (curved arrow). P = placenta. (b) Sagittal MR image shows the urine-filled renal collecting system and bladder (white arrow) with high signal intensity. The male genitalia (black arrow) are seen inferior to the bladder. Arrowhead indicates the kidneys. (5) Normal non-CNS findings in a 29-week-old fetus. (a) Coronal MR image shows the kidneys (arrowheads) adjacent to the spine. (b) Coronal MR image obtained anterior to a shows the liver with low signal intensity and the gallbladder filled with fluid (arrowhead). The stomach (black arrow) and the urinary bladder (white arrow) are also visible. The diaphragm is clearly seen separating the thorax from the abdomen.

View larger version (163K): [in a new window]   Figures 4, 5. (4) Normal non-CNS findings in a 27-week-old fetus. (a) Sagittal MR image shows various anatomic features highlighted by high-signal-intensity amniotic fluid, including the facial profile (straight solid arrow), the oropharynx (arrowhead), the foot (open arrow), and loops of the three-vessel umbilical cord (curved arrow). P = placenta. (b) Sagittal MR image shows the urine-filled renal collecting system and bladder (white arrow) with high signal intensity. The male genitalia (black arrow) are seen inferior to the bladder. Arrowhead indicates the kidneys. (5) Normal non-CNS findings in a 29-week-old fetus. (a) Coronal MR image shows the kidneys (arrowheads) adjacent to the spine. (b) Coronal MR image obtained anterior to a shows the liver with low signal intensity and the gallbladder filled with fluid (arrowhead). The stomach (black arrow) and the urinary bladder (white arrow) are also visible. The diaphragm is clearly seen separating the thorax from the abdomen.

View larger version (158K): [in a new window]   Figures 4, 5. (4) Normal non-CNS findings in a 27-week-old fetus. (a) Sagittal MR image shows various anatomic features highlighted by high-signal-intensity amniotic fluid, including the facial profile (straight solid arrow), the oropharynx (arrowhead), the foot (open arrow), and loops of the three-vessel umbilical cord (curved arrow). P = placenta. (b) Sagittal MR image shows the urine-filled renal collecting system and bladder (white arrow) with high signal intensity. The male genitalia (black arrow) are seen inferior to the bladder. Arrowhead indicates the kidneys. (5) Normal non-CNS findings in a 29-week-old fetus. (a) Coronal MR image shows the kidneys (arrowheads) adjacent to the spine. (b) Coronal MR image obtained anterior to a shows the liver with low signal intensity and the gallbladder filled with fluid (arrowhead). The stomach (black arrow) and the urinary bladder (white arrow) are also visible. The diaphragm is clearly seen separating the thorax from the abdomen.

View larger version (168K): [in a new window]   Figures 4, 5. (4) Normal non-CNS findings in a 27-week-old fetus. (a) Sagittal MR image shows various anatomic features highlighted by high-signal-intensity amniotic fluid, including the facial profile (straight solid arrow), the oropharynx (arrowhead), the foot (open arrow), and loops of the three-vessel umbilical cord (curved arrow). P = placenta. (b) Sagittal MR image shows the urine-filled renal collecting system and bladder (white arrow) with high signal intensity. The male genitalia (black arrow) are seen inferior to the bladder. Arrowhead indicates the kidneys. (5) Normal non-CNS findings in a 29-week-old fetus. (a) Coronal MR image shows the kidneys (arrowheads) adjacent to the spine. (b) Coronal MR image obtained anterior to a shows the liver with low signal intensity and the gallbladder filled with fluid (arrowhead). The stomach (black arrow) and the urinary bladder (white arrow) are also visible. The diaphragm is clearly seen separating the thorax from the abdomen.

View larger version (145K): [in a new window]   Figure 6a.   Normal non-CNS findings in a 29-week-old fetus. (a) Axial MR image of the thorax demonstrates the main pulmonary vessels (black arrow) and shows the heart with relatively low signal intensity (arrowhead). The interventricular cardiac septum is identified (white arrow), but other intracardiac details are obscured by motion artifact. The normal lung has high signal intensity owing to its fluid content. (b) Axial MR image shows the low-signal-intensity aorta and inferior vena cava (straight arrow), fluid-filled bowel loops (curved arrow), and the kidneys (arrowheads). As the fetus develops, the lower-signal-intensity renal cortex can be distinguished from the higher-signal-intensity medulla and the urine-filled renal collecting system.

View larger version (155K): [in a new window]   Figure 6b.   Normal non-CNS findings in a 29-week-old fetus. (a) Axial MR image of the thorax demonstrates the main pulmonary vessels (black arrow) and shows the heart with relatively low signal intensity (arrowhead). The interventricular cardiac septum is identified (white arrow), but other intracardiac details are obscured by motion artifact. The normal lung has high signal intensity owing to its fluid content. (b) Axial MR image shows the low-signal-intensity aorta and inferior vena cava (straight arrow), fluid-filled bowel loops (curved arrow), and the kidneys (arrowheads). As the fetus develops, the lower-signal-intensity renal cortex can be distinguished from the higher-signal-intensity medulla and the urine-filled renal collecting system.

View larger version (125K): [in a new window]   Figure 7a.   Arnold-Chiari malformation in a 20-week-old fetus. (a) Axial MR image shows neural elements extending through the posterior elemental defect in the spine (arrowhead). (b) Axial MR image shows a fluid-filled myelomeningocele extending into the amniotic fluid (arrowhead).

View larger version (135K): [in a new window]   Figure 7b.   Arnold-Chiari malformation in a 20-week-old fetus. (a) Axial MR image shows neural elements extending through the posterior elemental defect in the spine (arrowhead). (b) Axial MR image shows a fluid-filled myelomeningocele extending into the amniotic fluid (arrowhead).

View larger version (120K): [in a new window]   Figure 8a.   Arnold-Chiari malformation in the same fetus as in Figure 7. (a) On a coronal MR image, the lateral ventricles are dilated with a "bat-wing" appearance. (b) Sagittal MR image demonstrates hydrocephalus, a small posterior fossa, and a low-lying cerebellum (white arrowhead). More caudally, there is a posterior elemental defect in the low lumbar spine with a myelomeningocele (black arrowhead).

View larger version (126K): [in a new window]   Figure 8b.   Arnold-Chiari malformation in the same fetus as in Figure 7. (a) On a coronal MR image, the lateral ventricles are dilated with a "bat-wing" appearance. (b) Sagittal MR image demonstrates hydrocephalus, a small posterior fossa, and a low-lying cerebellum (white arrowhead). More caudally, there is a posterior elemental defect in the low lumbar spine with a myelomeningocele (black arrowhead).

View larger version (144K): [in a new window]   Figures 9, 10.   (9) Walker-Warburg syndrome in a 27-week-old fetus. (a) Axial MR image shows prominent lateral ventricles with only a thin rim of smooth cerebral tissue (arrow) and no differentiation between gray and white matter. (b) Coronal MR image shows prominent lateral ventricles with a "dangling choroid plexus" appearance (arrow). (c) Sagittal MR image shows a prominent, fluid-filled posterior fossa with a paucity of cerebellar tissue (arrowhead). The brain stem appears abnormally small. Autopsy helped confirm complex anomalies of the CNS, including microcephaly; thinned, lissencephalic cerebral hemispheres; cerebellar hypoplasia; and partial absence of the corpus callosum (Walker-Warburg syndrome). (10) Amniotic band syndrome in a 21-week-old fetus. Sagittal midline MR image shows an abnormally truncated fetal head and absence of the normal calvaria with only amorphous soft tissue present. No cerebral hemispheres (arrowhead), cerebellum, or facial features including the orbits (arrow) are evident.

View larger version (148K): [in a new window]   Figures 9, 10.   (9) Walker-Warburg syndrome in a 27-week-old fetus. (a) Axial MR image shows prominent lateral ventricles with only a thin rim of smooth cerebral tissue (arrow) and no differentiation between gray and white matter. (b) Coronal MR image shows prominent lateral ventricles with a "dangling choroid plexus" appearance (arrow). (c) Sagittal MR image shows a prominent, fluid-filled posterior fossa with a paucity of cerebellar tissue (arrowhead). The brain stem appears abnormally small. Autopsy helped confirm complex anomalies of the CNS, including microcephaly; thinned, lissencephalic cerebral hemispheres; cerebellar hypoplasia; and partial absence of the corpus callosum (Walker-Warburg syndrome). (10) Amniotic band syndrome in a 21-week-old fetus. Sagittal midline MR image shows an abnormally truncated fetal head and absence of the normal calvaria with only amorphous soft tissue present. No cerebral hemispheres (arrowhead), cerebellum, or facial features including the orbits (arrow) are evident.

View larger version (175K): [in a new window]   Figures 9, 10.   (9) Walker-Warburg syndrome in a 27-week-old fetus. (a) Axial MR image shows prominent lateral ventricles with only a thin rim of smooth cerebral tissue (arrow) and no differentiation between gray and white matter. (b) Coronal MR image shows prominent lateral ventricles with a "dangling choroid plexus" appearance (arrow). (c) Sagittal MR image shows a prominent, fluid-filled posterior fossa with a paucity of cerebellar tissue (arrowhead). The brain stem appears abnormally small. Autopsy helped confirm complex anomalies of the CNS, including microcephaly; thinned, lissencephalic cerebral hemispheres; cerebellar hypoplasia; and partial absence of the corpus callosum (Walker-Warburg syndrome). (10) Amniotic band syndrome in a 21-week-old fetus. Sagittal midline MR image shows an abnormally truncated fetal head and absence of the normal calvaria with only amorphous soft tissue present. No cerebral hemispheres (arrowhead), cerebellum, or facial features including the orbits (arrow) are evident.

View larger version (128K): [in a new window]   Figures 9, 10.   (9) Walker-Warburg syndrome in a 27-week-old fetus. (a) Axial MR image shows prominent lateral ventricles with only a thin rim of smooth cerebral tissue (arrow) and no differentiation between gray and white matter. (b) Coronal MR image shows prominent lateral ventricles with a "dangling choroid plexus" appearance (arrow). (c) Sagittal MR image shows a prominent, fluid-filled posterior fossa with a paucity of cerebellar tissue (arrowhead). The brain stem appears abnormally small. Autopsy helped confirm complex anomalies of the CNS, including microcephaly; thinned, lissencephalic cerebral hemispheres; cerebellar hypoplasia; and partial absence of the corpus callosum (Walker-Warburg syndrome). (10) Amniotic band syndrome in a 21-week-old fetus. Sagittal midline MR image shows an abnormally truncated fetal head and absence of the normal calvaria with only amorphous soft tissue present. No cerebral hemispheres (arrowhead), cerebellum, or facial features including the orbits (arrow) are evident.

View larger version (152K): [in a new window]   Figures 11, 12.   (11) Bilateral renal agenesis in a 26-week-old fetus. (a) Sagittal midline MR image demonstrates nearly complete absence of amniotic fluid with crowding of the fetus. The thoracic cavity is small and dominated by the heart (arrowhead). Typical high-signal-intensity lung tissue is not seen. The bladder is not apparent. Image quality is poor owing to the lack of surrounding amniotic fluid and fluid within the viscera. (b) Axial MR image shows the renal fossae to be devoid of normal-appearing renal structures (arrowheads) and filled with loops of small bowel. (12) Multicystic dysplastic kidney in a 23-week-old fetus. (a) Sagittal MR image shows a large, multicystic structure in the left renal fossa (arrowhead). The cysts vary in size and are not connected, findings that are consistent with multicystic dysplastic kidney. The stomach is seen just inferior to the diaphragm (arrow). (b) Sagittal MR image shows a normal right kidney (arrowhead).

View larger version (143K): [in a new window]   Figures 11, 12.   (11) Bilateral renal agenesis in a 26-week-old fetus. (a) Sagittal midline MR image demonstrates nearly complete absence of amniotic fluid with crowding of the fetus. The thoracic cavity is small and dominated by the heart (arrowhead). Typical high-signal-intensity lung tissue is not seen. The bladder is not apparent. Image quality is poor owing to the lack of surrounding amniotic fluid and fluid within the viscera. (b) Axial MR image shows the renal fossae to be devoid of normal-appearing renal structures (arrowheads) and filled with loops of small bowel. (12) Multicystic dysplastic kidney in a 23-week-old fetus. (a) Sagittal MR image shows a large, multicystic structure in the left renal fossa (arrowhead). The cysts vary in size and are not connected, findings that are consistent with multicystic dysplastic kidney. The stomach is seen just inferior to the diaphragm (arrow). (b) Sagittal MR image shows a normal right kidney (arrowhead).

View larger version (159K): [in a new window]   Figures 11, 12.   (11) Bilateral renal agenesis in a 26-week-old fetus. (a) Sagittal midline MR image demonstrates nearly complete absence of amniotic fluid with crowding of the fetus. The thoracic cavity is small and dominated by the heart (arrowhead). Typical high-signal-intensity lung tissue is not seen. The bladder is not apparent. Image quality is poor owing to the lack of surrounding amniotic fluid and fluid within the viscera. (b) Axial MR image shows the renal fossae to be devoid of normal-appearing renal structures (arrowheads) and filled with loops of small bowel. (12) Multicystic dysplastic kidney in a 23-week-old fetus. (a) Sagittal MR image shows a large, multicystic structure in the left renal fossa (arrowhead). The cysts vary in size and are not connected, findings that are consistent with multicystic dysplastic kidney. The stomach is seen just inferior to the diaphragm (arrow). (b) Sagittal MR image shows a normal right kidney (arrowhead).

View larger version (159K): [in a new window]   Figures 11, 12.   (11) Bilateral renal agenesis in a 26-week-old fetus. (a) Sagittal midline MR image demonstrates nearly complete absence of amniotic fluid with crowding of the fetus. The thoracic cavity is small and dominated by the heart (arrowhead). Typical high-signal-intensity lung tissue is not seen. The bladder is not apparent. Image quality is poor owing to the lack of surrounding amniotic fluid and fluid within the viscera. (b) Axial MR image shows the renal fossae to be devoid of normal-appearing renal structures (arrowheads) and filled with loops of small bowel. (12) Multicystic dysplastic kidney in a 23-week-old fetus. (a) Sagittal MR image shows a large, multicystic structure in the left renal fossa (arrowhead). The cysts vary in size and are not connected, findings that are consistent with multicystic dysplastic kidney. The stomach is seen just inferior to the diaphragm (arrow). (b) Sagittal MR image shows a normal right kidney (arrowhead).

View larger version (158K): [in a new window]   Figure 13a.   Infradiaphragmatic extralobar bronchopulmonary sequestration in a 28-week-old fetus. (a) Coronal MR image shows a well-circumscribed, high-signal-intensity infradiaphragmatic mass (arrow) superior to and separate from the left kidney (arrowhead). (b) On an axial MR image, the mass (thick arrow) is seen medial to the stomach (thin arrow) and abutting the left side of the aorta (small arrowhead). The right kidney appears normal (large arrowhead).

View larger version (156K): [in a new window]   Figure 13b.   Infradiaphragmatic extralobar bronchopulmonary sequestration in a 28-week-old fetus. (a) Coronal MR image shows a well-circumscribed, high-signal-intensity infradiaphragmatic mass (arrow) superior to and separate from the left kidney (arrowhead). (b) On an axial MR image, the mass (thick arrow) is seen medial to the stomach (thin arrow) and abutting the left side of the aorta (small arrowhead). The right kidney appears normal (large arrowhead).

View larger version (139K): [in a new window]   Figure 14.   Limb-body wall defect in an 18-week-old fetus. Sagittal MR image shows a large abdominal wall defect, with the liver, stomach, and bowel spilling into the amniotic fluid (arrowhead). The thorax and lungs appear hypoplastic and hypointense (arrow). A large myelomeningocele is seen protruding posteriorly. The normal pelvic girdle and the lower extremities are not visualized.

View larger version (165K): [in a new window]   Figures 15, 16.   (15) Clubfoot with arthrogryposis in a 21-week-old fetus. (a) Sagittal MR image shows inversion of the foot (arrow), a finding that is suggestive of clubfoot. Five toes are partially visualized (arrowhead). The hips are flexed and the knees extended. (b) Coronal MR image shows the wrists in a flexed position (arrows). (16) Diaphragmatic hernia in a 33-week-old fetus. (a) Coronal MR image shows an intact left hemidiaphragm, a normal-appearing left lung (arrowhead), and a large right-sided diaphragmatic hernia. The liver, the gallbladder, and bowel loops are seen filling the right side of the thorax (arrow). Only a small portion of the right lung is visible. (b) Sagittal MR image shows the liver, the gallbladder, and bowel loops (straight arrow) herniating through the right side of the diaphragm into the thorax and compressing the right lung (curved arrow).

View larger version (138K): [in a new window]   Figures 15, 16.   (15) Clubfoot with arthrogryposis in a 21-week-old fetus. (a) Sagittal MR image shows inversion of the foot (arrow), a finding that is suggestive of clubfoot. Five toes are partially visualized (arrowhead). The hips are flexed and the knees extended. (b) Coronal MR image shows the wrists in a flexed position (arrows). (16) Diaphragmatic hernia in a 33-week-old fetus. (a) Coronal MR image shows an intact left hemidiaphragm, a normal-appearing left lung (arrowhead), and a large right-sided diaphragmatic hernia. The liver, the gallbladder, and bowel loops are seen filling the right side of the thorax (arrow). Only a small portion of the right lung is visible. (b) Sagittal MR image shows the liver, the gallbladder, and bowel loops (straight arrow) herniating through the right side of the diaphragm into the thorax and compressing the right lung (curved arrow).

View larger version (157K): [in a new window]   Figures 15, 16.   (15) Clubfoot with arthrogryposis in a 21-week-old fetus. (a) Sagittal MR image shows inversion of the foot (arrow), a finding that is suggestive of clubfoot. Five toes are partially visualized (arrowhead). The hips are flexed and the knees extended. (b) Coronal MR image shows the wrists in a flexed position (arrows). (16) Diaphragmatic hernia in a 33-week-old fetus. (a) Coronal MR image shows an intact left hemidiaphragm, a normal-appearing left lung (arrowhead), and a large right-sided diaphragmatic hernia. The liver, the gallbladder, and bowel loops are seen filling the right side of the thorax (arrow). Only a small portion of the right lung is visible. (b) Sagittal MR image shows the liver, the gallbladder, and bowel loops (straight arrow) herniating through the right side of the diaphragm into the thorax and compressing the right lung (curved arrow).

View larger version (151K): [in a new window]   Figures 15, 16.   (15) Clubfoot with arthrogryposis in a 21-week-old fetus. (a) Sagittal MR image shows inversion of the foot (arrow), a finding that is suggestive of clubfoot. Five toes are partially visualized (arrowhead). The hips are flexed and the knees extended. (b) Coronal MR image shows the wrists in a flexed position (arrows). (16) Diaphragmatic hernia in a 33-week-old fetus. (a) Coronal MR image shows an intact left hemidiaphragm, a normal-appearing left lung (arrowhead), and a large right-sided diaphragmatic hernia. The liver, the gallbladder, and bowel loops are seen filling the right side of the thorax (arrow). Only a small portion of the right lung is visible. (b) Sagittal MR image shows the liver, the gallbladder, and bowel loops (straight arrow) herniating through the right side of the diaphragm into the thorax and compressing the right lung (curved arrow).