Fetal Thoracic Abnormalities: MR Imaging

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Abstract
To elucidate the appearance of fetal thoracic abnormalities at prenatal magnetic resonance (MR) imaging and determine whether MR imaging yields information additional to that obtained with ultrasonography (US). US and MR imaging data from 83 MR examinations of 74 fetuses with thoracic abnormalities and confirmatory US performed within 1 week before MR imaging were compared with respect to resulting changes in patient counseling and/or care. Lung parenchyma and lesion signal intensities and vascularity, airway, esophagus, and diaphragm appearances were reviewed retrospectively on MR images. Student t tests and analyses of variance were performed. MR imaging yielded information additional to that acquired with US in 28 (38%) of 74 fetuses. The additional findings were confirmed in 19 of the 28 fetuses at postnatal follow-up; no follow-up data were available for the other nine fetuses. Thoracic MR information affected care with regard to six (8%) of 74 fetuses. Mean gestational age of 15 fetuses with lung signal intensity (SI) slightly lower than that of amniotic fluid (28.4 weeks +/- 6.8 [SD]) at T2-weighted MR imaging was significantly older than that of 18 fetuses with intermediate SI (21.3 weeks +/- 4.3) (P <.05). Mean SI of 13 congenital cystic adenomatoid malformations (CCAMs) and/or sequestrations (1.74 +/- 1.05) at T2-weighted MR imaging was significantly higher than that of the normal lungs of 33 fetuses (2.63 +/-.63) (P <.001). Among nine studies in which vessels were visualized in CCAMs and/or sequestrations, six involved a normal vascular branching pattern. Portions of the esophagus were seen in 31 (36%) of 85 fetuses. Nonvisualization of a major airway was not sufficient for diagnosis of pulmonary atresia. Visualization of a portion of the esophagus did not correlate with esophageal atresia. In all except one fetus, who had anhydramnios and pulmonary hypoplasia, and the fetuses with congenital diaphragmatic hernia, at least a portion of the diaphragm was visualized at MR imaging. MR imaging yields information additional to that yielded with US in fetuses with thoracic abnormalities.