Fetal brain MRI in polyhydramnios: is it justified?

Area of Science:

• Medical Imaging
• Fetal Medicine
• Neurology

Background:

• Polyhydramnios, characterized by excessive amniotic fluid, often necessitates detailed fetal anomaly assessment.
• Congenital anomalies, particularly central nervous system (CNS) anomalies, are frequently associated with polyhydramnios.
• Current diagnostic methods, primarily ultrasound, may not detect all CNS anomalies in utero.

Purpose of the Study:

• To evaluate the diagnostic contribution of fetal brain Magnetic Resonance Imaging (MRI) in detecting CNS anomalies in fetuses diagnosed with polyhydramnios.
• To compare the detection rates of CNS anomalies between fetal brain MRI and standard ultrasound.

Main Methods:

• Retrospective cohort study involving 46 fetuses with polyhydramnios referred to a tertiary center.
• All fetuses underwent both detailed fetal ultrasound and fetal brain MRI.
• Comparison of MRI findings with ultrasound findings and differentiation between isolated and nonisolated polyhydramnios.

Main Results:

• Fetal brain MRI detected CNS anomalies in 50% (23/46) of cases, compared to 26% (12/46) detected by ultrasound.
• MRI demonstrated a significantly higher detection rate of anomalies in nonisolated polyhydramnios (62.9%) versus isolated polyhydramnios (31.6%).
• MRI identified additional CNS anomalies not detected by initial sonographic evaluation.

Conclusions:

• Fetal brain MRI enhances the detection of CNS anomalies in fetuses with polyhydramnios.
• MRI offers valuable insights beyond standard ultrasound for comprehensive fetal assessment.
• Further studies are warranted to assess the clinical utility and cost-effectiveness of routine fetal brain MRI in polyhydramnios management.