Fetal MR in the evaluation of pulmonary and digestive system pathology

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Abstract

Background

Prenatal awareness of an anomaly ensures better management of the pregnant patient, enables medical teams and parents to prepare for the delivery, and is very useful for making decisions about postnatal treatment. Congenital malformations of the thorax, abdomen, and gastrointestinal tract are common. As various organs can be affected, accurate location and morphological characterization are important for accurate diagnosis.

Methods

Magnetic resonance imaging (MRI) enables excellent discrimination among tissues, making it a useful adjunct to ultrasonography (US) in the study of fetal morphology and pathology.

Results

MRI is most useful when US has detected or suspected anomalies, and more anomalies are detected when MRI and US findings are assessed together.

Conclusion

We describe the normal appearance of fetal thoracic, abdominal, and gastrointestinal structures on MRI, and we discuss the most common anomalies involving these structures and the role of MRI in their study.

Teaching Points

• To learn about the normal anatomy of the fetal chest, abdomen, and GI tract on MRI.

• To recognize the MR appearance of congenital anomalies of the lungs and the digestive system .

• To understand the value of MRI when compared to US in assessing fetal anomalies.

Related collections

Most cited references 27

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Intestinal atresia and stenosis: a 25-year experience with 277 cases.

J Grosfeld, Randy Scherer, Cristiane L. Dalla Corte … (1998)

To evaluate the causes, clinical presentation, diagnosis, operative management, postoperative care, and outcome in infants with intestinal atresia. Retrospective case series. Pediatric tertiary care teaching hospital. A population-based sample of 277 neonates with intestinal atresia and stenosis treated from July 1, 1972, through April 30, 1997. The level of obstruction was duodenal in 138 infants, jejunoileal in 128, and colonic in 21. Of the 277 neonates, 10 had obstruction in more than 1 site. Duodenal atresia was associated with prematurity (46%), maternal polyhydramnios (33%), Down syndrome (24%), annular pancreas (33%), and malrotation (28%). Jejunoileal atresia was associated with intrauterine volvulus, (27%), gastroschisis (16%), and meconium ileus (11.7%). Patients with duodenal obstruction were treated by duodenoduodenostomy in 119 (86%), of 138 patients duodenotomy with web excision in 9 (7%), and duodenojejunostomy in 7 (5%) A duodenostomy tube was placed in 3 critically ill neonates. Patients with jejunoileal atresia were treated with resection in 97 (76%) of 128 patients (anastomosis, 45 [46%]; tapering enteroplasty, 23 [24%]; or temporary ostomy, 29 [30%]), ostomy alone in 25 (20%), web excision in 5 (4%), and the Bianchi procedure in 1 (0.8%). Patients with colon atresia were managed with initial ostomy and delayed anastomosis in 18 (86%) of 21 patients and resection with primary anastomosis in 3 (14%). Short-bowel syndrome was noted in 32 neonates. Morbidity and early and late mortality. Operative mortality for neonates with duodenal atresia was 4%, with jejunoileal atresia, 0.8%, and with colonic atresia, 0%. The long-term survival rate for children with duodenal atresia was 86%; with jejunoileal atresia, 84%; and with colon atresia, 100%. The Bianchi procedure (1 patient, 0.8%) and growth hormone, glutamine, and modified diet (4 patients, 1%) reduced total parenteral nutrition dependence. Cardiac anomalies (with duodenal atresia) and ultrashort-bowel syndrome (<40 cm) requiring long-term total parenteral nutrition, which can be complicated by liver disease (with jejunoileal atresia), are the major causes of morbidity and mortality in these patients. Use of growth factors to enhance adaptation and advances in small bowel transplantation may improve long-term outcomes.

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Situs revisited: imaging of the heterotaxy syndrome.

K E Applegate, M Goske, G N Pierce … (2015)

Situs anomalies present a diagnostic challenge to radiologists because of the overlapping spectrum of findings commonly seen in asplenia and polysplenia. In a series of 21 patients with a diagnosis of heterotaxy syndrome, all 11 asplenic patients and seven of 10 polysplenic patients had congenital heart disease. Although there was a variety of complex congenital heart disease, the most common type in both patient groups was a common atrioventricular canal. In both groups, the laterality of the aorta and stomach was quite variable, but intestinal malrotation was a constant feature. In 11 asplenic patients, the most frequent findings were a bridging liver (10 cases), absent spleen (10 cases), and left-sided inferior vena cava (nine cases). Only seven of these patients had an aorta ipsilateral to the inferior vena cava, contrary to previous thought that this finding was specific for asplenia. In the 10 polysplenic patients, bridging livers were less frequent (five cases), single (six cases) or multiple (four cases) spleens were seen, and azygous continuation with interruption of the inferior vena cava was usually present (eight cases). Although not pathognomonic of polysplenia, inferior vena cava interruption with azygous or hemiazygous continuation is the most common anatomic finding of this condition. Although the terms asplenia and polysplenia are helpful in suggesting the typical anatomy, both syndromes encompass an overlapping spectrum that needs to be described individually and may best be called heterotaxy syndrome.

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Congenital cystic lung disease: contemporary antenatal and postnatal management.

Timothy M. Crombleholme, Richard G Azizkhan (2008)

Congenital cystic lung disease comprises a broad spectrum of rare but clinically significant developmental abnormalities, including congenital pulmonary adenomatoid malformations, bronchopulmonary sequestrations, bronchogenic cysts, and congenital lobar emphysema that result from perturbations in lung and airway embryogenesis. As congenital lung lesions are now more commonly recognized antenatally, mothers require accurate prenatal counseling and appropriate perinatal management. In light of long-term complications of infection and malignancy, there is growing consensus that infants with asymptomatic lesions should undergo elective excision of congenital pulmonary adenomatoid malformation (CPAM) or bronchopulmonary sequestration (BPS). This review will focus on advancements and current practice in the diagnosis and management of CPAM and BPS, identifying aspects of the literature that are confusing or controversial. Although our knowledge and pre- and postnatal management of lung lesions will continue to evolve and improve, there is a compelling need for a unified clinical and pathological classification system that creates a common platform for discussion, clinical management, and research.

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Author and article information

Contributors

: +34-9322-75735 , +34-9322-79317 , andarnel@clinic.ub.es

Journal

Journal ID (nlm-ta): Insights Imaging

Journal ID (iso-abbrev): Insights Imaging

Title: Insights into Imaging

Publisher: Springer-Verlag (Berlin/Heidelberg )

ISSN (Electronic): 1869-4101

Publication date (Electronic): 18 April 2012

Publication date PMC-release: 18 April 2012

Publication date Collection: June 2012

Volume: 3

Issue: 3

Pages: 277-293

Affiliations

[1 ]Radiology Department, UDIAT CD, Institut Universitari Parc Taulí-UAB, Sabadell, Spain

[2 ]Radiology Department, Hospital Clínic, Barcelona, Spain

Article

Publisher ID: 155

DOI: 10.1007/s13244-012-0155-2

PMC ID: 3369121

PubMed ID: 22696089

SO-VID: 4963e393-2bd2-45da-b409-ff96483ee8f0

History

Date received : 6 November 2011

Date revision received : 2 February 2012

Date accepted : 20 February 2012

Custom metadata

ScienceOpen disciplines: Radiology & Imaging

Keywords: congenital abnormalities,imaging, magnetic resonance imaging,gastrointestinal tract,abdomen,thorax

Data availability:

ScienceOpen disciplines: Radiology & Imaging

Keywords: congenital abnormalities, imaging, magnetic resonance imaging, gastrointestinal tract, abdomen, thorax

Fetal MR in the evaluation of pulmonary and digestive system pathology

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Abstract

Background

Methods

Results

Conclusion

Teaching Points

Related collections

Probing cerebral hemodynamics with BOLD fMRI

Most cited references 27

Intestinal atresia and stenosis: a 25-year experience with 277 cases.

Situs revisited: imaging of the heterotaxy syndrome.

Congenital cystic lung disease: contemporary antenatal and postnatal management.

Author and article information

Contributors

Journal

Affiliations

Article

History

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