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Prenatal diagnosis of bowel malposition using T2-weighted fetal MRI sequences
M Kheiri1, E Lesieur2, A Dabadie1
1Service d'imagerie pédiatrique et prénatale, Hôpital Timone Enfants, Marseille, France.
Objective:
The goal of this study was to investigate the capability of T2-weighted magnetic resonance imaging (MRI) in revealing fetal bowel malposition.
Materials And Methods:
All fetal MRI examinations (excluding central nervous system MRI examinations) performed in our department from January 2005 to January 2014 were retrospectively studied by 2 independent observers for situs, stomach and jejunum location on T2-weighted images. Patients data were also reviewed for results of ultrasound examinations, MRI indication, and gestational age. Abnormally positioned jejunums were classified into 3 groups: intrathoracic (A), extra-fetal (B) and abnormal intra-fetal (C). Prenatal data were compared to postnatal imaging, surgery or autopsy findings that served as standard of reference.
Results:
A total of 709 fetal MRI examinations were analyzed. In 64 fetus (9%), the jejunum was not present in the left subgastric area on T2-weighted MR images. In these 64 fetuses, proximal jejunum was intrathoracic (41/64, 64%, group A), extra-fetal (11/64, 17%, group B), or intra-abdominal but abnormally positioned (12/64, 19%, group C). Interobserver agreement was 100%. All diagnoses for fetuses in groups A and B (52 cases) were confirmed postnatally (41 cases) or at autopsy (11 cases). In group C, bowel malposition was suspected after ultrasound in only 2/12 fetuses (16.6%); it was confirmed postnatally in 1 fetus but not confirmed in the remaining one. In the 10 remaining fetuses (83%), malposition was confirmed postnatally although not initially suspected.
Conclusion:
T2-weighted fetal MR images are useful for the prenatal diagnosis of bowel malposition, even when they are unsuspected on ultrasound examination.
Insights
T2-weighted fetal magnetic resonance imaging (MRI) effectively detects fetal bowel malposition, even when ultrasound misses it. This imaging technique aids in prenatal diagnosis of conditions like intrathoracic or extra-fetal jejunum.
Area of Science:
- Medical Imaging
- Fetal Medicine
- Radiology
Background:
- Fetal bowel malposition can be challenging to diagnose prenatally.
- Accurate prenatal detection is crucial for appropriate management and outcomes.
Purpose of the Study:
- To evaluate the efficacy of T2-weighted fetal magnetic resonance imaging (MRI) in identifying fetal bowel malposition.
- To assess the diagnostic performance of MRI compared to ultrasound and postnatal findings.
Main Methods:
- Retrospective analysis of 709 fetal MRI examinations over a 10-year period.
- Two independent observers assessed jejunum location on T2-weighted images.
- Categorization of malpositions into intrathoracic, extra-fetal, and abnormal intra-fetal groups.
Main Results:
- T2-weighted MRI identified fetal bowel malposition in 9% of cases (64/709 fetuses).
- Intrathoracic and extra-fetal malpositions were highly accurate, confirmed postnatally or at autopsy.
- MRI detected abnormal intra-fetal positioning in 83% of cases not suspected by ultrasound.
Conclusions:
- T2-weighted fetal MRI is a valuable tool for prenatal diagnosis of bowel malposition.
- MRI can reveal unsuspected cases of fetal bowel malposition, improving diagnostic accuracy.
- This imaging modality enhances prenatal assessment and management planning for fetal gastrointestinal abnormalities.
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