[Fetal cerebral magnetic resonance imaging (MRI). Indications, normal and pathological patterns]

Fetal MRI is a specific imaging modality, always performed after a reference ultrasound examination. The decision to perform an MRI-scan must take into account the anxiety constantly generated by the need for this unusual examination during pregnancy. To date, no side-effect associated with 1.5 tesla magnets has been described. Compared to ultrasonography, fetal brain MRI provides better contrast between grey and white matter, as well as better delineation of the brainstem (pontic curvature) and the cerebellum (lobules and fissures). However, it often remains difficult to inform parents about prognosis. Thereby, it is of utmost importance to be familiar with the definite criteria associated with a poor neurological prognosis such as lack of pontic curvature or as diffuse or bilateral cortical malformations. This has to be considered within the framework of French regulations which allow pregnancy termination with no time limit. The optimal timing to perform a fetal MRI-scan depends on the context. The period between 27 and 30 weeks of gestation is a good balance between gestational age and gyration or sulcation development. The main ultrasonographic findings requiring MRI are ventriculomegalies and posterior fossa abnormalities. MRI exploration can sometimes be performed despite a normal ultrasonography in case of genetic disorders such as tuberous sclerosis and lissencephalies. In addition to its diagnostic value towards decision to terminate pregnancy, fetal MRI can be used as "in vivo autopsy", in case of expected technical difficulties or refusal of post-abortion examinations by relatives. Technical advances (real time and specific sequences like diffusion tensor and spectroscopy) and prospective clinical studies will probably improve the efficiency of this method to assess neurological prognosis.