Fetal MRI Useful in Pre-Surgery Assessment and Treatment Planning

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Area physicians are turning to fetal MRI (Magnetic Resonance Imaging), as an adjunct to standard ultrasound imaging, to evaluate potentially serious fetal anomalies. Although ultrasound remains the primary fetal imaging technique of choice, MRI is becoming used more often for planning therapeutic interventions and confirming congenital diagnosis.

MRI technology enables images to be acquired in less than one second and provide multiplanar views that help physicians more accurately acquire a diagnosis and plan for prenatal surgery or design postnatal treatments. A fetal MRI is generally ordered after a suspected anomaly is spotted with ultrasound or if the mother is at risk for a condition that cannot be visualized well with sonography.

One distinct advantage of MRI is its ability to produce precise and detailed images of the fetal brain and spinal cord. As an example, in cases of intrauterine growth retardation, it can help in assessing damage to the fetal brain. The procedure can also be used as an adjunct to invasive fetal therapy.

Fetal MRI works particularly well in identifying ventriculomegaly, lesions within the posterior fossa, callosal anomalies and abnormalities in cerebral myelination, migration, and sulcation. It is also a strong problem-solving tool for finding suspected conditions such as diaphragmatic hernia, congenital cystic adenomatoid malformations, renal cystic lesions, and other complicated abdominal masses.

In addition, a fetal MRI provides potentially critical information about the maternal abdomen and, in some cases, can reveal problems with the pregnant patient or indicate possible problems that may occur during pregnancy. Frequently, MRI is used to identify or monitor conditions such as appendicitis or placenta accreta/percreta, both of which can be life threatening.

“Fetal MRI is really a secondary diagnostic examination to define abnormalities that cannot be visualized by other appraoches or to confirm a suspected or inconclusive diagnosis” stated Dr. Terri Lewis, an Inland Imaging radiologist specializing in pediatric imaging.

Prior to a fetal MRI, a sonogram is needed to assess the viability and the position of the fetus. The MRI should only be done during the third trimester of gestation because the fetus is too small to obtain adequate images if conducted any earlier.

A fetal MRI requires no maternal preparation, fetal sedation, or contrast media administration. There are no proven hazards from the procedure, other than maternal discomfort while lying still during the exam. The technique is only recommended when it could change the delivery plan or treatment of the mother during her pregnancy. A perinatologist, an OB/GYN who specializes in high-risk pregnancies, generally orders the imaging test.

During the procedure, a surface coil is placed over the abdomen and pelvis and the mother is placed in the MRI machine. Several image planes are captured in order to specifically view what clinicians are looking for.

MRI technology has become much faster and accurate over the past several years, decreasing scan time and increasing image quality. Up until a few years ago, a fetal MRI was hampered due to fetal motion. Sedation was needed to reduce fetal activity and motion during the exam. However, as ultrafast MRI techniques and technology have advanced, the need for sedation has almost been eliminated.

Over the past year, Inland Imaging has conducted several MRI procedures specifically for fetal anomalies. However, MRI exams on pregnant women are commonly ordered to evaluate the abdomen or kidneys.

Dr. Lewis concluded “We are pleased to provide fetal MRI as an additional diagnostic tool that can assist physicians, mothers, and their child with the information needed to establish the appropriate treatment regimen or course of care.”