MR Imaging of Non-CNS Fetal Abnormalities: A Pictorial Essay1
Hiroshi Shinmoto, MD,
Kyoko Kashima, MD,
Yuji Yuasa, MD,
Akihiro Tanimoto, MD,
Yasuhide Morikawa, MD,
Hitoshi Ishimoto, MD,
Yasunori Yoshimura, MD and
Kyoichi Hiramatsu, MD
1 From the Departments of Diagnostic Radiology (H.S., K.K., Y. Yuasa, A.T., K.H.), Pediatric Surgery (Y.M.), and Obstetrics and Gynecology (H.I., Y. Yoshimura), Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Presented as a scientific exhibit at the 1999 RSNA scientific assembly. Received February 1, 2000; revision requested March 17 and received April 24; accepted April 25. Address correspondence to H.S. (e-mail: shinmoto@med.keio.ac.jp).
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Figure 1a. Normal anatomy in a 35-week-old fetus as shown on single-shot fast spin-echo MR images. Coronal images are presented from anterior (a) to posterior (f). (a) Image shows the scrotum (arrow). (b) Image shows the thymus (open arrow) and urinary bladder (solid arrow). (c) Image shows the heart (arrow), liver (*), and stomach (arrowhead). (d) Image shows the trachea (solid white arrow), gallbladder (open white arrow), and jejunum (black arrow). (e) Image shows the right kidney (arrow). (f) Image shows the spleen (arrow) and left kidney (arrowhead).
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Figure 1b. Normal anatomy in a 35-week-old fetus as shown on single-shot fast spin-echo MR images. Coronal images are presented from anterior (a) to posterior (f). (a) Image shows the scrotum (arrow). (b) Image shows the thymus (open arrow) and urinary bladder (solid arrow). (c) Image shows the heart (arrow), liver (*), and stomach (arrowhead). (d) Image shows the trachea (solid white arrow), gallbladder (open white arrow), and jejunum (black arrow). (e) Image shows the right kidney (arrow). (f) Image shows the spleen (arrow) and left kidney (arrowhead).
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Figure 1c. Normal anatomy in a 35-week-old fetus as shown on single-shot fast spin-echo MR images. Coronal images are presented from anterior (a) to posterior (f). (a) Image shows the scrotum (arrow). (b) Image shows the thymus (open arrow) and urinary bladder (solid arrow). (c) Image shows the heart (arrow), liver (*), and stomach (arrowhead). (d) Image shows the trachea (solid white arrow), gallbladder (open white arrow), and jejunum (black arrow). (e) Image shows the right kidney (arrow). (f) Image shows the spleen (arrow) and left kidney (arrowhead).
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Figure 1d. Normal anatomy in a 35-week-old fetus as shown on single-shot fast spin-echo MR images. Coronal images are presented from anterior (a) to posterior (f). (a) Image shows the scrotum (arrow). (b) Image shows the thymus (open arrow) and urinary bladder (solid arrow). (c) Image shows the heart (arrow), liver (*), and stomach (arrowhead). (d) Image shows the trachea (solid white arrow), gallbladder (open white arrow), and jejunum (black arrow). (e) Image shows the right kidney (arrow). (f) Image shows the spleen (arrow) and left kidney (arrowhead).
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Figure 1e. Normal anatomy in a 35-week-old fetus as shown on single-shot fast spin-echo MR images. Coronal images are presented from anterior (a) to posterior (f). (a) Image shows the scrotum (arrow). (b) Image shows the thymus (open arrow) and urinary bladder (solid arrow). (c) Image shows the heart (arrow), liver (*), and stomach (arrowhead). (d) Image shows the trachea (solid white arrow), gallbladder (open white arrow), and jejunum (black arrow). (e) Image shows the right kidney (arrow). (f) Image shows the spleen (arrow) and left kidney (arrowhead).
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Figure 1f. Normal anatomy in a 35-week-old fetus as shown on single-shot fast spin-echo MR images. Coronal images are presented from anterior (a) to posterior (f). (a) Image shows the scrotum (arrow). (b) Image shows the thymus (open arrow) and urinary bladder (solid arrow). (c) Image shows the heart (arrow), liver (*), and stomach (arrowhead). (d) Image shows the trachea (solid white arrow), gallbladder (open white arrow), and jejunum (black arrow). (e) Image shows the right kidney (arrow). (f) Image shows the spleen (arrow) and left kidney (arrowhead).
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Figure 2a. Normal anatomy in a 35-week-old fetus (same subject as in Fig 1) as shown on T1-weighted fast spin-echo MR images. Coronal images are presented from anterior (a) to posterior (f). The distal ileum (arrowhead) and entire colon (black arrow) show high signal intensity. White arrow = rectum.
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Figure 2b. Normal anatomy in a 35-week-old fetus (same subject as in Fig 1) as shown on T1-weighted fast spin-echo MR images. Coronal images are presented from anterior (a) to posterior (f). The distal ileum (arrowhead) and entire colon (black arrow) show high signal intensity. White arrow = rectum.
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Figure 2c. Normal anatomy in a 35-week-old fetus (same subject as in Fig 1) as shown on T1-weighted fast spin-echo MR images. Coronal images are presented from anterior (a) to posterior (f). The distal ileum (arrowhead) and entire colon (black arrow) show high signal intensity. White arrow = rectum.
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Figure 2d. Normal anatomy in a 35-week-old fetus (same subject as in Fig 1) as shown on T1-weighted fast spin-echo MR images. Coronal images are presented from anterior (a) to posterior (f). The distal ileum (arrowhead) and entire colon (black arrow) show high signal intensity. White arrow = rectum.
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Figure 2e. Normal anatomy in a 35-week-old fetus (same subject as in Fig 1) as shown on T1-weighted fast spin-echo MR images. Coronal images are presented from anterior (a) to posterior (f). The distal ileum (arrowhead) and entire colon (black arrow) show high signal intensity. White arrow = rectum.
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Figure 2f. Normal anatomy in a 35-week-old fetus (same subject as in Fig 1) as shown on T1-weighted fast spin-echo MR images. Coronal images are presented from anterior (a) to posterior (f). The distal ileum (arrowhead) and entire colon (black arrow) show high signal intensity. White arrow = rectum.
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Figure 3a. Normal thyroid in a 34-week-old fetus. (a) Coronal T1-weighted fast spin-echo MR image shows the thyroid as a symmetric, hyperintense structure (arrows). (b) Coronal single-shot fast spin-echo MR image shows the thyroid as isointense compared with surrounding structures.
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Figure 3b. Normal thyroid in a 34-week-old fetus. (a) Coronal T1-weighted fast spin-echo MR image shows the thyroid as a symmetric, hyperintense structure (arrows). (b) Coronal single-shot fast spin-echo MR image shows the thyroid as isointense compared with surrounding structures.
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Figure 4a. Goiter in a 30-week-old fetus. (a) Sagittal T1-weighted fast spin-echo MR image shows a huge anterior neck mass with homogeneous high signal intensity, which suggests the diagnosis of fetal goiter. (b) Sagittal single-shot fast spin-echo MR image shows the mass, which is isointense and compresses the bright trachea posteriorly (arrowhead). (c) Axial T1-weighted fast spin-echo MR image obtained at 35 weeks gestation after intrauterine hormonal therapy shows the goiter, which is now smaller and has the normal symmetric thyroid shape.
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Figure 4b. Goiter in a 30-week-old fetus. (a) Sagittal T1-weighted fast spin-echo MR image shows a huge anterior neck mass with homogeneous high signal intensity, which suggests the diagnosis of fetal goiter. (b) Sagittal single-shot fast spin-echo MR image shows the mass, which is isointense and compresses the bright trachea posteriorly (arrowhead). (c) Axial T1-weighted fast spin-echo MR image obtained at 35 weeks gestation after intrauterine hormonal therapy shows the goiter, which is now smaller and has the normal symmetric thyroid shape.
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Figure 4c. Goiter in a 30-week-old fetus. (a) Sagittal T1-weighted fast spin-echo MR image shows a huge anterior neck mass with homogeneous high signal intensity, which suggests the diagnosis of fetal goiter. (b) Sagittal single-shot fast spin-echo MR image shows the mass, which is isointense and compresses the bright trachea posteriorly (arrowhead). (c) Axial T1-weighted fast spin-echo MR image obtained at 35 weeks gestation after intrauterine hormonal therapy shows the goiter, which is now smaller and has the normal symmetric thyroid shape.
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Figure 5. Congenital diaphragmatic hernia in a 36-week-old fetus. Coronal single-shot fast spin-echo MR image shows the stomach (straight solid arrow), small intestine (open arrow), and colon (arrowhead) to the left of the mediastinum. The mediastinal structures are shifted to the right, and the lungs show marked hypoplasia. The normal right hemidiaphragm is clearly seen (curved arrow).
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Figure 6a. Type II cystic adenomatoid malformation in a 29-week-old fetus. (a) Coronal single-shot fast spin-echo MR image shows multiple small cysts in the lower lobe of the right lung. (b) Coronal gadolinium-enhanced MR angiogram obtained 4 days after birth clearly shows an aberrant artery from the abdominal aorta.
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Figure 6b. Type II cystic adenomatoid malformation in a 29-week-old fetus. (a) Coronal single-shot fast spin-echo MR image shows multiple small cysts in the lower lobe of the right lung. (b) Coronal gadolinium-enhanced MR angiogram obtained 4 days after birth clearly shows an aberrant artery from the abdominal aorta.
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Figure 7a. Bronchopulmonary sequestration in a 23-week-old fetus. (a) Oblique sagittal US scan shows cystic structures in a hyperechoic left lung (the cranial direction of the fetus is on the right). This appearance was diagnosed as cystic adenomatoid malformation. (b, c) Oblique coronal single-shot fast spin-echo MR images show the left side of the thorax mostly occupied by an abnormal mass with small cysts (arrowhead), which compresses the hypoplastic left lung superiorly (arrow in b). The mass is markedly hyperintense relative to the normal right lung. An aberrant artery from the descending aorta is seen as a flow void (arrow in c). (d) Autopsy photograph shows an extralobar sequestration covered by normal pleura with an aberrant vessel. The hypoplastic left lung can be separately identified (arrow).
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Figure 7b. Bronchopulmonary sequestration in a 23-week-old fetus. (a) Oblique sagittal US scan shows cystic structures in a hyperechoic left lung (the cranial direction of the fetus is on the right). This appearance was diagnosed as cystic adenomatoid malformation. (b, c) Oblique coronal single-shot fast spin-echo MR images show the left side of the thorax mostly occupied by an abnormal mass with small cysts (arrowhead), which compresses the hypoplastic left lung superiorly (arrow in b). The mass is markedly hyperintense relative to the normal right lung. An aberrant artery from the descending aorta is seen as a flow void (arrow in c). (d) Autopsy photograph shows an extralobar sequestration covered by normal pleura with an aberrant vessel. The hypoplastic left lung can be separately identified (arrow).
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Figure 7c. Bronchopulmonary sequestration in a 23-week-old fetus. (a) Oblique sagittal US scan shows cystic structures in a hyperechoic left lung (the cranial direction of the fetus is on the right). This appearance was diagnosed as cystic adenomatoid malformation. (b, c) Oblique coronal single-shot fast spin-echo MR images show the left side of the thorax mostly occupied by an abnormal mass with small cysts (arrowhead), which compresses the hypoplastic left lung superiorly (arrow in b). The mass is markedly hyperintense relative to the normal right lung. An aberrant artery from the descending aorta is seen as a flow void (arrow in c). (d) Autopsy photograph shows an extralobar sequestration covered by normal pleura with an aberrant vessel. The hypoplastic left lung can be separately identified (arrow).
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Figure 7d. Bronchopulmonary sequestration in a 23-week-old fetus. (a) Oblique sagittal US scan shows cystic structures in a hyperechoic left lung (the cranial direction of the fetus is on the right). This appearance was diagnosed as cystic adenomatoid malformation. (b, c) Oblique coronal single-shot fast spin-echo MR images show the left side of the thorax mostly occupied by an abnormal mass with small cysts (arrowhead), which compresses the hypoplastic left lung superiorly (arrow in b). The mass is markedly hyperintense relative to the normal right lung. An aberrant artery from the descending aorta is seen as a flow void (arrow in c). (d) Autopsy photograph shows an extralobar sequestration covered by normal pleura with an aberrant vessel. The hypoplastic left lung can be separately identified (arrow).
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Figure 8a. Gastroschisis in a 28-week-old fetus. (a) Sagittal single-shot fast spin-echo MR image shows a midline abdominal wall defect and prolapse of a bowel loop (arrow) into the amniotic fluid. (b) Follow-up sagittal MR image obtained 3 weeks later shows progressive change in the bowel prolapse; the markedly dilated small bowel loops are clearly identified (arrow). Polyhydramnios has increased in volume.
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Figure 8b. Gastroschisis in a 28-week-old fetus. (a) Sagittal single-shot fast spin-echo MR image shows a midline abdominal wall defect and prolapse of a bowel loop (arrow) into the amniotic fluid. (b) Follow-up sagittal MR image obtained 3 weeks later shows progressive change in the bowel prolapse; the markedly dilated small bowel loops are clearly identified (arrow). Polyhydramnios has increased in volume.
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Figure 9a. Omphalocele in a 35-week-old fetus. (a) Sagittal single-shot fast spin-echo MR image shows prolapse of the liver (white arrowhead) and small bowel loops (black arrowhead) into an omphalocele sac as a lump. (b) Axial single-shot fast spin-echo MR image also shows prolapse of the stomach (solid arrow) and colon (open arrow).
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Figure 9b. Omphalocele in a 35-week-old fetus. (a) Sagittal single-shot fast spin-echo MR image shows prolapse of the liver (white arrowhead) and small bowel loops (black arrowhead) into an omphalocele sac as a lump. (b) Axial single-shot fast spin-echo MR image also shows prolapse of the stomach (solid arrow) and colon (open arrow).
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Figure 10a. Hiatal hernia in a 31-week-old fetus. (a) Coronal single-shot fast spin-echo MR image shows the stomach (arrow) protruding through the esophageal hiatus. (b) Barium esophagogram shows a sliding hiatal hernia.
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Figure 10b. Hiatal hernia in a 31-week-old fetus. (a) Coronal single-shot fast spin-echo MR image shows the stomach (arrow) protruding through the esophageal hiatus. (b) Barium esophagogram shows a sliding hiatal hernia.
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Figure 11a. Duodenal atresia in a 35-week-old fetus. (a) Coronal single-shot fast spin-echo MR image shows dilatation of the stomach (top arrow) and the proximal portion of the duodenum (bottom arrow), producing a "double bubble" appearance. (b) Coronal T1-weighted fast spin-echo MR image shows an empty small intestine and a meconium-filled colon (arrow). The distention of the stomach and the duodenum suggests duodenal atresia. (c) Radiograph obtained after birth shows distention of the stomach and proximal duodenum.
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Figure 11b. Duodenal atresia in a 35-week-old fetus. (a) Coronal single-shot fast spin-echo MR image shows dilatation of the stomach (top arrow) and the proximal portion of the duodenum (bottom arrow), producing a "double bubble" appearance. (b) Coronal T1-weighted fast spin-echo MR image shows an empty small intestine and a meconium-filled colon (arrow). The distention of the stomach and the duodenum suggests duodenal atresia. (c) Radiograph obtained after birth shows distention of the stomach and proximal duodenum.
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Figure 11c. Duodenal atresia in a 35-week-old fetus. (a) Coronal single-shot fast spin-echo MR image shows dilatation of the stomach (top arrow) and the proximal portion of the duodenum (bottom arrow), producing a "double bubble" appearance. (b) Coronal T1-weighted fast spin-echo MR image shows an empty small intestine and a meconium-filled colon (arrow). The distention of the stomach and the duodenum suggests duodenal atresia. (c) Radiograph obtained after birth shows distention of the stomach and proximal duodenum.
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Figure 12. Small bowel atresia in a 31-week-old fetus. Coronal single-shot fast spin-echo MR image shows equally distended small bowel loops with homogeneous high signal intensity, an appearance suggestive of proximal small bowel obstruction.
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Figure 13. Double small bowel atresia in a 34-week-old fetus. Coronal single-shot fast spin-echo MR images (presented from anterior [top left] to posterior [bottom right]) show small bowel distention with two different patterns of signal intensity, an appearance suggestive of multiple obstructions. At surgery, the presence of two obstructions was confirmed and two separate distended small intestines were seen.
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Figure 14a. Small bowel atresia with meconium peritonitis in a 33-week-old fetus. Coronal single-shot fast spin-echo MR images (presented from anterior [a] to posterior [c]) show a huge cystic structure (arrow in a) and a small amount of ascites in the abdomen. The stomach (arrowhead in b) and small bowel loops (arrow in b) appear normal. The diagnosis of ileal perforation and meconium pseudocyst with underlying ileal atresia was confirmed at surgery.
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Figure 14b. Small bowel atresia with meconium peritonitis in a 33-week-old fetus. Coronal single-shot fast spin-echo MR images (presented from anterior [a] to posterior [c]) show a huge cystic structure (arrow in a) and a small amount of ascites in the abdomen. The stomach (arrowhead in b) and small bowel loops (arrow in b) appear normal. The diagnosis of ileal perforation and meconium pseudocyst with underlying ileal atresia was confirmed at surgery.
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Figure 14c. Small bowel atresia with meconium peritonitis in a 33-week-old fetus. Coronal single-shot fast spin-echo MR images (presented from anterior [a] to posterior [c]) show a huge cystic structure (arrow in a) and a small amount of ascites in the abdomen. The stomach (arrowhead in b) and small bowel loops (arrow in b) appear normal. The diagnosis of ileal perforation and meconium pseudocyst with underlying ileal atresia was confirmed at surgery.
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Figure 15. Ureteropelvic junction obstruction in a 31-week-old fetus. Coronal single-shot fast spin-echo MR image shows a dilated right renal pelvis without dilatation of the ureter, an appearance indicative of ureteropelvic junction obstruction.
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Figure 16a. Duplicated renal collecting system and ureterocele in a 34-week-old fetus. (a) Coronal single-shot fast spin-echo MR image shows a duplicated right renal collecting system. (b) Coronal single-shot fast spin-echo MR image shows an ectopic ureterocele (arrow) associated with dilatation of the upper calices. (c, d) Intravenous pyelogram (c) and MR urogram (d) obtained 12 days after birth show bilateral duplicated collecting systems with right upper caliectasis (arrows) and a huge filling defect in the urinary bladder.
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Figure 16b. Duplicated renal collecting system and ureterocele in a 34-week-old fetus. (a) Coronal single-shot fast spin-echo MR image shows a duplicated right renal collecting system. (b) Coronal single-shot fast spin-echo MR image shows an ectopic ureterocele (arrow) associated with dilatation of the upper calices. (c, d) Intravenous pyelogram (c) and MR urogram (d) obtained 12 days after birth show bilateral duplicated collecting systems with right upper caliectasis (arrows) and a huge filling defect in the urinary bladder.
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Figure 16c. Duplicated renal collecting system and ureterocele in a 34-week-old fetus. (a) Coronal single-shot fast spin-echo MR image shows a duplicated right renal collecting system. (b) Coronal single-shot fast spin-echo MR image shows an ectopic ureterocele (arrow) associated with dilatation of the upper calices. (c, d) Intravenous pyelogram (c) and MR urogram (d) obtained 12 days after birth show bilateral duplicated collecting systems with right upper caliectasis (arrows) and a huge filling defect in the urinary bladder.
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Figure 16d. Duplicated renal collecting system and ureterocele in a 34-week-old fetus. (a) Coronal single-shot fast spin-echo MR image shows a duplicated right renal collecting system. (b) Coronal single-shot fast spin-echo MR image shows an ectopic ureterocele (arrow) associated with dilatation of the upper calices. (c, d) Intravenous pyelogram (c) and MR urogram (d) obtained 12 days after birth show bilateral duplicated collecting systems with right upper caliectasis (arrows) and a huge filling defect in the urinary bladder.
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Figure 17a. Multicystic dysplastic kidney in a 34-week-old fetus. (a) Oblique sagittal US scan obtained at 33 weeks gestation shows multiple cysts in the left side of the abdomen (the cranial direction of the fetus is on the right). The cysts mimic small bowel dilatation. (b) Coronal single-shot fast spin-echo MR image shows multiple large cysts in the left kidney without normal renal parenchyma. The right kidney is normal.
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Figure 17b. Multicystic dysplastic kidney in a 34-week-old fetus. (a) Oblique sagittal US scan obtained at 33 weeks gestation shows multiple cysts in the left side of the abdomen (the cranial direction of the fetus is on the right). The cysts mimic small bowel dilatation. (b) Coronal single-shot fast spin-echo MR image shows multiple large cysts in the left kidney without normal renal parenchyma. The right kidney is normal.
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Figure 18a. Potter syndrome in a 34-week-old fetus. Coronal single-shot fast spin-echo MR images show bilateral renal dysplasia (arrows in a), hypoplastic lungs (arrows in b), and oligohydramnios, findings compatible with Potter syndrome.
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Figure 18b. Potter syndrome in a 34-week-old fetus. Coronal single-shot fast spin-echo MR images show bilateral renal dysplasia (arrows in a), hypoplastic lungs (arrows in b), and oligohydramnios, findings compatible with Potter syndrome.
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Figure 19a. Liver tumor (infantile hemangioendothelioma) in a 40-week-old fetus. (a, b) Coronal (a) and axial (b) single-shot fast spin-echo MR images show an inhomogeneous tumor (arrows) hanging from the lower aspect of the left hepatic lobe. (c) Contrast material-enhanced computed tomographic scan obtained 3 days after birth shows the characteristic findings of a hemangioma. (d) Surgical photograph shows the tumor, which was proved to be an infantile hemangioendothelioma.
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Figure 19b. Liver tumor (infantile hemangioendothelioma) in a 40-week-old fetus. (a, b) Coronal (a) and axial (b) single-shot fast spin-echo MR images show an inhomogeneous tumor (arrows) hanging from the lower aspect of the left hepatic lobe. (c) Contrast material-enhanced computed tomographic scan obtained 3 days after birth shows the characteristic findings of a hemangioma. (d) Surgical photograph shows the tumor, which was proved to be an infantile hemangioendothelioma.
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Figure 19c. Liver tumor (infantile hemangioendothelioma) in a 40-week-old fetus. (a, b) Coronal (a) and axial (b) single-shot fast spin-echo MR images show an inhomogeneous tumor (arrows) hanging from the lower aspect of the left hepatic lobe. (c) Contrast material-enhanced computed tomographic scan obtained 3 days after birth shows the characteristic findings of a hemangioma. (d) Surgical photograph shows the tumor, which was proved to be an infantile hemangioendothelioma.
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Figure 19d. Liver tumor (infantile hemangioendothelioma) in a 40-week-old fetus. (a, b) Coronal (a) and axial (b) single-shot fast spin-echo MR images show an inhomogeneous tumor (arrows) hanging from the lower aspect of the left hepatic lobe. (c) Contrast material-enhanced computed tomographic scan obtained 3 days after birth shows the characteristic findings of a hemangioma. (d) Surgical photograph shows the tumor, which was proved to be an infantile hemangioendothelioma.
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Figure 20. Sacrococcygeal teratoma in a 31-week-old fetus. Sagittal single-shot fast spin-echo MR image shows a large multilocular cystic mass in the sacrococcygeal region. An isointense nodular component is seen (arrow), and no communication with the dural sac could be appreciated. The diagnosis of sacrococcygeal teratoma was confirmed at neonatal surgery.
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Figure 21. Meningocele in a 37-week-old fetus. Sagittal single-shot fast spin-echo MR image shows a large multilocular cystic mass in the sacrococcygeal region, an appearance similar to that in Figure 20. There is a communication between the cyst and the thecal sac (arrow), a finding suggestive of meningocele.
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Copyright © 2000 by the Radiological Society of North America.
