Sherelle Laifer-Narin

Fetal magnetic resonance imaging: a review.

Purpose of review To describe advances in magnetic resonance technology and the current indications and advantages of magnetic resonance imaging that have led to increased utilization in fetal medicine. Recent findings The article covers the most common uses of magnetic resonance imaging in fetal medicine. The advantages of magnetic resonance imaging for the diagnosis of fetal malformations are described, in particular the advantages of magnetic resonance imaging in central nervous system malformations not optimally diagnosed by ultrasound are described. These cases include malformations of migration, malformations of development, such as agenesis of the corpus callosum, and destructive lesions. Noncentral nervous system lesions include chest abnormalities, abdominal wall defects, gastrointestinal and genitourinary abnormalities and fetal neoplasms. Abnormalities of placentation and other maternal factors affecting pregnancy are shown. Summary Recent studies have shown that magnetic resonance imaging can add significantly to the prenatal diagnosis and management of congenital abnormalities. In addition, placental abnormalities have been diagnosed with greater accuracy.

Multimodality imaging of the postpartum or posttermination uterus: evaluation using ultrasound, computed tomography, and magnetic resonance imaging.

Postpartum and posttermination complications are common causes of morbidity and mortality in women of reproductive age. These complications can be broadly categorized into vascular, infectious, surgical, and neoplastic etiologies, or are due to ectopic implantation of placental or endometrial tissue. Causes of postpartum vascular complications include retained products of conception, arteriovenous malformation, and pseudoaneurysm. Infectious entities include endometritis, abscess, wound cellulitis, and pelvic septic thrombophlebitis. Postsurgical complications include uterine scar dehiscence, bladder flap hematoma, and subfascial hematoma. Neoplastic complications include the spectrum of gestational trophoblastic neoplasms. Ectopic tissue implantation complications include abnormal placentation and uterine scar endometriosis. Imaging is essential for diagnosis, and radiologists must be familiar with and aware of these entities so that accurate treatment and management can be obtained. In this review, we illustrate the imaging findings of common postpartum and posttermination complications on ultrasound, computed tomography, and magnetic resonance imaging.

Initial Experience With Propranolol Treatment of Lymphatic Anomalies: A Case Series.

Lymphatic malformations (LMs) are congenital lymphatic lesions that impose significant and costly morbidities on affected patients. Treatment options are limited due to incomplete understanding of LM pathobiology. Expression of an activated β2-adrenergic receptor has been described in LM tissue, suggesting that this pathway may contribute to the clinical manifestations of LM. We hypothesized that propranolol, a β-adrenergic receptor antagonist, might improve symptoms of patients with LMs and lymphatic anomalies. A retrospective chart review of patients treated with propranolol as an adjunct therapy was conducted; analyses included demographic characteristics, clinical features, and response to propranolol. Three patients with cystic and noncystic LMs displayed clinical improvement at a minimum dose of 0.7 mg/kg/d, whereas symptomatic relapses were observed when propranolol doses dropped below this threshold. Two patients with Klippel-Trenaunay syndrome demonstrated partial clinical responses with reduced edema. The fetus of a mother treated with propranolol from a gestational age of 35 weeks through delivery displayed arrested growth of a cervicofacial LM. Our retrospective review suggests that propranolol improved symptoms in a subset of patients with lymphatic anomalies. Propranolol treatment may also limit the growth of congenital LMs in utero.

Going out on a limb for a difficult diagnosis: a case report

Sacral tumors with fetiform features are rare and pose a diagnostic challenge to the ultrasonologist. Sacrococcygeal teratomas (SCT) and parasitic twins can have very similar sonographic features but have different implications to an affected pregnancy. While postnatal histopathology is ultimately necessary to distinguish between a SCT and a heteropagus twin, certain characteristics, such as the presence of a vertebral column and the pattern and rate of tumor growth, may be useful to guide counseling and management decisions.

The Role of Computed Tomography and Magnetic Resonance Imaging in Gynecologic Oncology

This article discusses the role of Computed tomography (CT) and MR imaging in gynecologic malignancies by reviewing epidemiology, histologic subtypes, and staging systems. Imaging findings specific to different gynecologic malignancies on CT and MR imaging are reviewed and the advantages of each imaging modality discussed. Imaging of endometrial, cervical, and ovarian cancer is reviewed in depth, with a brief discussion of rare gynecologic cancers.

P19.09: Fetal inguinal hernia: not always an isolated finding

Background: congenital inguinal hernias are rarely detected in utero, with prenatal diagnoses often made in the 3rd trimester. While most reported cases are isolated, fetal inguinal hernia has also been reported with rib and vertebral anomalies in the setting of Jarcho-Levin syndrome. Case: we report a case and associated images and video of a male infant prenatally diagnosed with a large inguinal hernia and multiple other anomalies. Prenatal ultrasound at 32 weeks revealed a large homogeneous solid mass anterior to the fetal pelvis measuring 4.70 × 4.62 × 4.88 cm adjacent to a normalappearing phallus (image 1). Peristalsis was noted within the mass, with bowel loops extending from the fetal abdomen into the mass suggesting an inguinal hernia (video). A normal cord insertion was noted. Additional anomalies apparent by prenatal sonogram included lumbosacral myelomeningocele with Chiari malformation, d-transposition of the great arteries, multiple hemivertebrae, and lower extremities fixed in flexion with short longs bones and bilateral talipes. Prenatal MRI confirmed the above findings. Amniocentesis revealed a normal male karyotype with a negative microarray. Cesarean delivery of a 2630 g male was performed at term due to breech presentation. Postnatal examination confirmed prenatal findings with no clinical or molecular evidence of a genetic abnormality. Conclusion: Inguinal hernias may be detected prenatally by identification of peristalsing bowel loops extending from the fetal abdomen into an external pelvic mass. Close evaluation for associated anomalies is required, as other structural anomalies may be present even the absence of a syndromic diagnosis.

OP12.05: The effectiveness of MRI in the prenatal diagnosis of placenta accreta

Objectives: The aim of this retrospective study was to compare the accuracy of 10 commonly used weight estimation formulas in a group of fetuses with extreme macrosomia (≥ 4.500 g). Methods: Ten different formulas were evaluated in a group of 174 fetuses with a birth weight (BW) ≥ 4.500 g. Each fetus underwent ultrasound examination with complete biometric parameters within 7 days of delivery. The accuracy of the different formulas for fetal weight estimation (FWE) was compared by mean percentage error (MPE), median of the absolute percentage error (MAPE), the ‘limitsof-agreement’ method and the percentage of FWE falling within the 10% range of the true birth weight. Results: MPE was largest with the Schild formula (MPE −15.43%) and the Shepard formula (MPE 6.08%) and closest to zero with the Hadlock III formula (MPE 5.34%). The MPE of all formulas showed significant bias when compared to zero. All tested formulas, except the Shepard and Shinozuka equations, significantly underestimated fetal weight. The Hadlock III formula obtained the highest percentage of FWE within the 10% range of the true birth weight (66.3%). However, formulas estimated fetal weight in less than two thirds of cases within the 10% range of the true birth weight. Conclusions: Exact weight estimation in extreme macrosomia remains an unsolved problem questioning clinical decisions solely based on ultrasound data.

OP22.06: Monochorionic twin pregnancies complicated by an anomalous co‐twin: fetal magnetic resonance imaging after radiofrequency ablation

Results: A total of 13 patients met inclusion criteria and were offered fetal cystoscopy and possible laser fulguration with confirmation of PUV. Seven patients decided to undergo fetal therapy and six elected to continue with expectant observation. There was no difference between both groups in gestation age at diagnosis and referral examinations or fetal urinary analysis. Urethral atresia was diagnosed in three cases (21.3%). At 26 weeks, fetuses that were managed expectantly presented with worse urinary biochemistry results (p < 0.05). Survival rates and percentage of infants with normal renal function were significantly higher in the cystoscopic laser group than in those cases that decided for prenatal expectant management. Conclusions: Percutaneous fetal cystoscopy is feasible using a thinner special cannula for prenatal diagnosis and therapy of LUTO. Prenatal laser ablation of the posterior urethra valves under cystoscopy may prevent renal function deterioration improving postnatal outcomes.