Beruflich Dokumente
Kultur Dokumente
DOI 10.1007/s00247-006-0353-5
ORIGINAL ARTICLE
Received: 23 June 2006 / Revised: 26 September 2006 / Accepted: 10 October 2006 / Published online: 29 November 2006
# Springer-Verlag 2006
diagnostic tool, guiding counseling, fetal therapy and Table 1 Imaging parameters for SSFSE and MR fetography
postnatal care [4, 6].
Parameter Technique
The fast T2-weighted imaging sequences are the main-
stay of most fetal examinations. T1-weighted, generally SSFSE MR fetography
gradient echo imaging is performed to evaluate brain
TR (ms) 4,000 16,000
myelination, hemorrhage, and meconium in bowel or liver
TE (ms) 88 180
position, but is otherwise of limited value because of the FOV (cm) 25–32 30–34
low contrast in the fetus. T2-weighted imaging is the most Slice (mm) 3–5 5/10
diagnostic because the majority of fetal structures are of Matrix 192/224 256/512
high water content. The bright signal of water on the T2-
weighted images provides excellent contrast and allows
better separation of adjacent organs. Heavily T2-weighted cava compression and secondary vasovagal reaction. In
hydrography sequences have been utilized successfully to addition, if the mother was claustrophobic, the supine
delineate fluid-filled structures, particularly in the urinary position accentuated this symptom. A phased array torso
system and biliary tract [7, 8]. Because normal and coil was placed concentrically around the patient centered
pathologic fetal tissues tend to be fluid-filled or surrounded at the level of the gravid uterus.
by fluid, our thought was that hydrography imaging (MR Imaging of the entire fetus was obtained but directed to
fetography) would be helpful to accentuate and further the area of suspected pathology. Sequence T2 parameters
define fetal pathology. are shown in Table 1. Both T2-weighted sequences were
performed through the area of pathology with imaging
anatomically in the axial, sagittal and coronal planes of the
Materials and methods fetus.
Results
within the mass solely with MR fetography (Figs. 5 and 6). performed for cardiac or vascular abnormalities. In three
This helped confirm the presence of two congenital cystic fetuses with a situs abnormality, there was no benefit. The
adenomatoid malformations. Finally, in the brain, MR MR fetography images were poor in two fetuses with renal
fetography sequence defined an area of nodularity in the agenesis and in two normal anatomy fetuses with premature
cortex of a frontal lobe, consistent with an area of cortical rupture of membranes.
malformation.
In 101 examinations (80%), the addition of the MR
fetography sequence subjectively increased the radiologist’s Discussion
confidence in the findings. As expected, it improved
visualization of structures with fluid-filled boundaries (14 Water is the largest constituent of the human body. Total
bowel, 5 renal collecting system, 3 biliary and 2 airway; body water content varies between individuals but is known
Figs. 7 and 8). The MR fetography imaging defined the to decrease with age. The human fetus is made up of
cyst border and architecture in 10 thoracic and 5 abdominal approximately 90% water, while adult water content
lesions (Figs. 9 and 10). This imaging also sharpened the normally ranges from 50% to 70% [9]. Prenatal sonography
detail of structures surrounded by fluid (52 cerebral, 7 utilizes the high water content of the fetus and amniotic
ventral wall defects and 5 spine lesions; Figs. 11 and 12). fluid environment to monitor normal and abnormal fetal
In 14 examinations (11%), MR fetography was not development. Fetal MR, which provides superior soft-tissue
beneficial. Seven of these studies were examinations contrast to sonography, is primarily obtained utilizing a T2-
Pediatr Radiol (2007) 37:133–140 137
weighted sequence, as this imaging highlights differences and the TE is increased to more than 140–160 ms, then a
between soft tissue and high water content structures and heavily T2-weighted hydrography image is obtained [11].
the amniotic fluid environment. In addition, because most With the hydrography method, the T2 effects of aqueous
fetal pathology is central nervous system or renal in origin, liquids are amplified because water has a long transverse
T2-weighted imaging is the modality of choice. and longitudinal magnetization when compared to other
The workhorses for fetal imaging have been the SSFSE, tissues [12]. When utilizing this technique, solid organs and
HASTE, UFSE and FASE sequences. These sequences are flowing blood or fluids have low signal intensity, whereas
also known as the half-Fourier single-shot RARE (rapid static fluids, such as cerebrospinal fluid, urine in the
acquisition with relaxation enhancement) technique. With collecting system, bile in the hepatobiliary system and
this imaging, phase encoding for sections are obtained after cysts in any organ, have high signal intensity [13].
a single 90° radiofrequency excitation and multiple 180° Hydrography imaging, designated by the anatomical area
refocusing pulses. Because only half of the K-space is of investigation, provides high-quality imaging contrast
sampled, the imaging time is decreased nearly twofold [10]. between fluid and background and is invaluable in studying
Data obtained from this sequence are of excellent quality static fluid pathology. In the biliary system, MR cholangi-
with good T2 weighting. More important, this imaging ography is commonly used to evaluate bile duct obstruc-
allows acquisition of a single slice at a time with each tion, postsurgical alterations and congenital anomalies [14].
image being obtained in milliseconds, significantly mini- MR urography is an asset in the evaluation of the renal
mizing motion artifact. Thus, if the fetus moves, only the parenchyma and perinephric processes and mimics excre-
slice or slices at the time of the motion in a group of images tory urography, defining urinary tract obstruction, filling
are blurred. defects in the urinary tract, and congenital anomalies [15,
Although SSFSE is excellent for fetal imaging, the half- 16]. MR myelography produces images with excellent
Fourier single-shot RARE technique has also been utilized spatial resolution of exiting nerve roots, the conus medul-
for other imaging purposes. In particular, if the TR is long laris and the cauda equina [17].
138 Pediatr Radiol (2007) 37:133–140
adjacent to an abnormality, then we do not perform MR 3. Frates CM, Dumar AJ, Benson CB et al (2004) Fetal anomalies:
fetography. We also do not use MR fetography imaging comparison of MR imaging and US for diagnosis. Radiology
232:398–404
when evaluating a fetus with cardiac or vascular pathology. 4. Quinn TM, Hubbard AM, Adzick NS (1998) Prenatal magnetic
Because multiple gestation examinations tend to be longer, resonance imaging enhances fetal diagnosis. J Pediatr Surg
as they require imaging of more than one fetus, we usually 33:553–558
perform the SSFSE routine sequence and do not prolong 5. Levine D (2001) Ultrasound versus magnetic resonance
imaging in fetal evaluation. Top Magn Reson Imaging 12:25–
the examination with MR fetography imaging unless we 38
believe strongly that evaluation of fetal pathology would be 6. Levine D (2006) Obstetric MRI. J Magn Reson Imaging 24:1–
improved with inclusion of the sequence. 15
7. Jara H, Barish MA, Yucel EK et al (1998) MR hydrography:
theory and practice of static fluid imaging. AJR 170:873–
882
Conclusion 8. Regan F, Calvaluzzi J, Nguyen B (1998) Fast MR abdominal
imaging using the HASTE sequence. AJR 170:1471–1476
9. Ellis KJ (1993) Human body composition: in vivo methods,
Fetal MR is becoming common practice for the evaluation of models and assessment. Plenum Press, New York
many fetal disorders after the identification of an abnormality 10. Chen Q, Levine D (2001) Fast fetal magnetic resonance imaging
on sonography. Fast imaging sequences implemented in the techniques. Top Magn Reson Imaging 12:67–79
11. Barish MA, Soto JA (1997) MR cholangiopancreatography:
1990s have improved fetal imaging by minimizing motion techniques and clinical applications. AJR 169:1295–1303
artifact. Although SSFSE and HASTE imaging are currently 12. Westbrook C, Kaut C (1994) MRI in practice. Blackwell
the workhorses for fetal imaging, MR fetography is an Scientific Publications, Oxford, UK
excellent adjunct. Because of the high water content in 13. Roy C, Saussine C, Jacqmin D (2000) Magnetic resonance
urography. BJU Int 86 [Suppl 1]:42–47
normal fetal anatomy and fetal pathology, this sequence can 14. Fulcher AS, Turner MA, Capps GW (1999) MR cholangiography:
elucidate additional findings, increase confidence in the technical advances and clinical applications. Radiographics
diagnosis, and provide high resolution and contrast images 19:25–41
that are well received by clinicians and families. 15. Avni FE, Nicaise N, Hall M et al (2001) The role of MR imaging
for the assessment of complicated duplex kidneys in children:
preliminary report. Pediatr Radiol 31:215–223
16. Blandino A, Gaeta M, Minutoli F et al (2002) MR urography of
the ureter. AJR 179:1307–1314
17. Nagayam M, Watanabe Y, Okumura A et al (2002) High-
References resolution single-slice MR myelography. AJR 179:515–521
18. Chaumoitre K, Wikberg E, Shojai R et al (2006) Fetal magnetic
1. Coakley F, Glenn OA, Qayyum A et al (2004) Fetal MRI: a resonance hydrography: evaluation of single-shot thick-slab
developing technique for the developing patient. AJR 182:243–252 RARE (rapid acquisition with relaxation enhancement) sequence
2. Glastonbury CM, Kennedy AM (2002) Ultrafast MRI of the fetus. in fetal thoracoabdominal pathology. Ultrasound Obstet Gynecol
Australas Radiol 46:22–32 27:537–544
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