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Published on: January 7, 2021
Low Conus Position on Fetal MRI with Postnatal Correlation
Tracie Y Kong1, Karin S Bierbrauer2, Jungwhan John Choi2
1From the Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. tracieykong@gmail.com.
AJNR. American Journal of Neuroradiology
|August 4, 2026
Summary
Prenatal MRI evaluation of low conus medullaris position using either vertebral level or kidney border landmarks can predict postnatal tethered cord syndrome. Both methods showed similar accuracy, suggesting combined use may enhance diagnostic confidence.
Area of Science:
- Medical Imaging
- Pediatric Neurology
- Fetal Medicine
Background:
- Abnormal low conus medullaris position on fetal MRI can indicate potential tethered cord syndrome.
- Prenatal identification of low conus is challenging, often requiring postnatal confirmation.
Purpose of the Study:
- To compare two fetal MRI methods for evaluating conus medullaris position.
- To correlate these methods with postnatal outcomes for tethered cord syndrome.
Main Methods:
- Retrospective cohort study of fetal MRIs (2011-2022) reporting low conus.
- Two classification methods: vertebral level vs. inferior renal border.
- Correlated with postnatal imaging and surgical detethering data.
Main Results:
- 203 fetal MRIs analyzed (224 fetuses); 15% had postnatal imaging.
- 65% confirmed low conus (L3 or below); 41% underwent detethering surgery.
- No significant difference in accuracy between the two evaluation methods (p=0.66).
Conclusions:
- Both vertebral and renal border landmarks on fetal MRI predict postnatal low conus.
- A combined approach in the third trimester may improve diagnostic confidence.
- Gestational age and other factors can influence interpretation of isolated low conus.
