FETAL MR for ABDOMINAL WALL DEFECT
Referring MD:
Clinical history:
Comparison is with complete obstetric ultrasound done today.
Best overall assessment of gestational age is determined to be
weeks days.
The MR study was performed without sedation or contrast after
informed consent was obtained. Sequences after bFFE localizers
consist primarily of T2-weighted single shot imaging with
additional bFFE images.
There is a single living intrauterine gestation in
vertex/breech/transverse position.
Appropriate fetal limb and cardiac motion is documented.
The fetus is phenotypically male/female.
The placenta is ventral/dorsal and away from the cervical os.
There is a normal volume of amniotic fluid.
There is a three vessel cord.
The cervix is long and closed.
There is no periuterine abnormality identified.
Composite dating according to ultrasound today is most consistent
with an EGA of 32 weeks, 3 days.
The MR findings in the fetus reveal an abdominal wall defect
consistent with an omphalocele containing organs.
MR right lung volume = 3
MR left lung volume = 4
TFLV
=5
O/E TFLV
= 6
No other fetal abnormality is detected.
IMPRESSION:
There is an abdominal wall defect consistent with an omphalocele
containing stuff.
The O/E TFLV is 8.
Based on the findings described above, the patient may benefit
from consultations with pediatric surgery and neonatology.
END OF IMPRESSION
Fetal MR for CDH
Referring MD:
Clinical History: congenital diaphragmatic hernia
Comparison is with complete obstetric ultrasound performed
today.
Best overall assessment of gestational age is determined to be
weeks days.
The MR study was performed without sedation or contrast.
Sequences after bFFE localizers consist primarily of T2-weighted
single shot imaging with additional bFFE images and a single T1weighted sequence.
Data was additionally manipulated to create a virtual 3 dimensional
image set for the calculation of fetal lung volumes. The key images
from this processing were added to the exam. This information is
essential for the proper prenatal counseling and clinical care of the
fetus by the fetal care team.
There is a single living intrauterine gestation in
vertex/breech/transverse position.
Appropriate fetal limb and cardiac motion is documented.
The fetus is phenotypically male/female.
The placenta is ventral/dorsal and away from the cervical os.
There is a normal volume of amniotic fluid.
There is a three vessel cord.
The cervix is long and closed.
There is no periuterine abnormality identified.
The MR findings in the fetus reveal a small/large right/left
intrapleural/mediastinal hernia with
liver/bowel/stomach/spleen/kidney within the right/left chest. There
is consequent mass effect and mediastinal shift to the left/right.
Except for the position, the heart is unremarkable. There is no
evidence of pericardial effusion, or any other evidence of hydrops.
There is no indication of a hernia sac. The right jugular vein is
imaged and is comparable in size to the left.
LHR
O/E LHR
MR right lung volume
MR left lung volume
TFLV
O/E TFLV
= 1
= 2
= 3
= 4
=5
= 6
Herniated Liver Volume = 7
Fetal Liver Volume
=8
% Liver Up
=9
No other fetal abnormality is detected.
IMPRESSION:
There is a large left diaphragmatic hernia containing much of the
left lobe of the liver, the stomach, and other organs. The LHR is
calculated at 10. The O/E TFLV is 11. The % liver up is 12.
Based on the findings described above, the patient may benefit
from consultations with pediatric surgery and neonatology.
END OF IMPRESSION:
Fetal MR report – Generic
Referring MD:
Clinical history:
Comparison is with complete obstetric ultrasound performed
today.
Best overall assessment of gestational age is determined to be
weeks days.
The MR study was performed without sedation or contrast after
informed consent was obtained. Sequences after BFFE localizers
consist primarily of T2-weighted single shot imaging, bTFE
sequences, and a single coronal T1-weighted sequence.
There is a single living intrauterine gestation in cephalic position.
Appropriate cardiac motion is documented.
The fetus is phenotypically male.
The placenta is dorsal and away from the cervical os.
There is a normal volume of amniotic fluid.
There is a three vessel cord.
The cervix is long and closed.
There is mild right maternal pelvicaliectasis.
The MR findings in the fetus reveal 5
I do not identify any other fetal abnormality.
IMPRESSION:
6
Based on the findings described above, the patient may benefit
from consultations with pediatric surgery.
END OF IMPRESSION:
Fetal MR for Neck Mass
Referring MD:
Clinical History:
Comparison is with complete obstetric ultrasound performed
today, and with prior MRI of January 27, 2012.
Best overall assessment of gestational age is determined to be
weeks days.
Fetal MRI was performed without sedation or contrast using FFE
localizers, single shot TSE T2 weighted, GRE T1 weighted, EPI and
bFFE sequences.
There is a single living intrauterine gestation in Field 1 position.
Cardiac motion is documented.
The fetus is phenotypically Field 2 male.
The placenta is Field 3, and away from the cervical os.
There is a high normal volume of amniotic fluid.
There is a three vessel cord.
The cervix is mm and closed.
There is no periuterine abnormality identified.
In the fetus there is a centric/infiltrative mass with mass effect on
Field 7 , measuring . This is cystic/solid and contains
calcifications/hemorrhage. Field 8
The TEDI (trachea-esophageal displacement index) is 14.
Field 9
Although there is local soft tissue edema, there is no indication of
hydrops today.
Field 10 No other abnormality is detected.
IMPRESSION:
Field 11
Field 12
Based on the findings described above, the patient may benefit
from consultations with pediatric surgery and neonatology.
END OF IMPRESSION:
Fetal MR for Congenital Lung Mass
Referring MD:
Clinical history: lung mass
The MR study was performed without sedation or contrast after
informed consent was obtained. Sequences after bFFE localizers
consist primarily of T2-weighted single shot imaging with
additional bFFE images.
Data was additionally manipulated to create a virtual 3 dimensional
image set for the calculation of fetal lung volumes. The key images
from this processing were added to the exam. This information is
essential for the proper prenatal counseling and clinical care of the
fetus by the fetal care team.
Comparison is with complete obstetric ultrasound performed
today.
Best overall assessment of gestational age is determined to be
weeks days.
There is a single living intrauterine gestation in vertex position.
Appropriate fetal limb and cardiac motion is documented.
The fetus is phenotypically male.
The placenta is dorsal, and away from the cervical os.
There is a normal volume of amniotic fluid.
There is a three vessel cord.
The cervix is long and closed.
There is no periuterine abnormality identified.
The MR findings reveal a large supradiaphragmatic mass in the left
chest, with the following characteristics:
inhomogeneous texture
does not conform to the expected shape/position of lung tissue;
does not contain cysts;
has pulmonary arterial supply and pulmonary venous drainage,
without vascular architectural distortion;
causes no mass effect to the right;
has an US-derived CVR of 1.6.
There is an additional finding of ascites.
No other fetal abnormality is detected.
IMPRESSION:
This lesion fits imaging characteristics for a segmental bronchial
atresia without complication.
Based on the findings described above, the patient may benefit
from consultations with pediatric surgery and neonatology.
END OF IMPRESSION:
Fetal MR for LUTO/oligohydramnios
Referring MD:
History:
Comparison is with complete obstetric ultrasound performed
today. Composite dating for this fetus is at 1w 2d.
There is a single living intrauterine gestation in breech position.
Appropriate cardiac motion is documented.
The fetus is phenotypically 3male.
The placenta is 4and away from the cervical os.
There is a 5volume of amniotic fluid.
There is a three vessel cord.
The cervix is long and closed.
The MR study was performed without sedation or contrast after
informed consent was obtained. Sequences after BFFE localizers
consist primarily of T2-weighted single shot imaging.
Data was additionally manipulated to create a virtual 3 dimensional
image set for the calculation of fetal lung volumes. The key images
from this processing were added to the exam. This information is
essential for the proper prenatal counseling and clinical care of the
fetus by the fetal care team.
The MR findings reveal 6.
I do not identify any other fetal abnormality.
IMPRESSION:
7
Based on the findings described above, the patient may benefit
from consultations with pediatric surgery, urology and
neonatology.
END OF IMPRESSION:
Fetal MR report – Neuro generic
Referring MD:
Clinical History: Ventriculomegaly
Comparison is with complete obstetric ultrasound done earlier
today.
Best overall assessment of gestational age is determined to be
weeks days.
The MR study was performed without sedation or contrast after
informed consent was obtained. Sequences after BFFE localizers
consist primarily of T2-weighted single shot imaging with
additional T1 weighted, EPI and DWI sequences through the brain.
There is a single living intrauterine gestation in vertex position.
Appropriate fetal limb and cardiac motion is documented.
The fetus is phenotypically female.
The placenta is dorsal and to the left, and away from the cervical
os.
There is a normal volume of amniotic fluid.
There is a three vessel cord. The cervix is long and closed.
In the fetus, MR findings reveal no obvious neural axis structural
abnormality. For example, there is no evidence of callosal
agenesis or hydrocephalus. I see nothing to suggest convincingly
that there is a migrational anomaly. The right lateral ventricle
measures 12 mm and the left measure 13 mm. Sulcation is
appropriate to gestational age.
No other abnormality is identified.
IMPRESSION:
END OF IMPRESSION:
Fetal MR for NTD
Referring MD:
Clinical history: neural tube defect
The MR study was performed without sedation or contrast after
informed consent was obtained. Sequences after BFFE localizers
consist primarily of T2-weighted single shot imaging, with
additional T1-weighted, EPI and DWI sequences through the brain.
Comparison is with complete obstetric ultrasound performed
earlier today.
Best overall assessment of gestational age is determined to be
weeks days.
There is a single living intrauterine gestation in vertex lie.
Appropriate fetal limb and cardiac motion is documented.
The fetus is phenotypically male.
The placenta is ventral and away from the cervical os.
There is a normal volume of amniotic fluid.
There is a three vessel cord.
The cervix is long and closed.
The MR findings in the fetus reveal an open neural tube defect that
lies between 1 and 2. This is associated with a cystic
myelomeningocele measuring approximately 3 in diameter. There
is a typical Chiari II configuration of the hindbrain, and the
transverse diameter of the atria of the lateral ventricles measures 4
mm currently on each side. There is no hydronephrosis. The
bladder appears grossly unremarkable. The lower extremities are
also within normal limits, without obvious clubbing.
No other fetal abnormality is detected.
IMPRESSION:
Open neural tube defect from 1 through 2. The configuration is
consistent with myelomeningocele and Chiari II malformation, with
5 lateral ventricular ventriculomegaly.
In utero repair inclusion/exclusion criteria:
INCLUSION
 Meningomyelocele begins between T1 and S1: 6
 Defect not suspected to be skin-covered:
6
 hindbrain herniation:
6
 GA is less than 26 weeks:
7
 maternal age is at least 18:
8
 the gestation is single:
9
 karyotype is normal:
10
EXCLUSION
 other fetal anomaly:
 fetal kyphosis of >30 degrees:
 uterine anomaly:
 previous hysterotomy:
 cerclage or cervix <20 mm:
 placenta previa:
 marginal or frank abruption:
 maternal IDDM:
 maternal BMI > 35
 previous uninduced delivery < 37 weeks:
 Rh+, Kell +, or neo alloimmune TCP:
 maternal HIV+, hep-B +, hep-C+:
 hypertension:
 contraindication to surgery/anesthesia:
 lack of support persons:
 psychosocial evaluation limiting:
12
13
21
22
14
15
16
11
17
18
19
20
23
24
25
26
Based on the findings described above, the patient may benefit
from consultations with pediatric neurosurgery and neurology.
END OF IMPRESSION:
MR for Placental Invasion
Referring MD:
Clinical history: History of prior cesarean section with low-lying
placenta. Evaluate for invasive placenta.
Comparison is with complete obstetric ultrasound performed date.
Best overall assessment of gestational age is determined to be
weeks days.
The MR study was performed without sedation or contrast.
Sequences after BFFE localizers consist primarily of T2-weighted
single shot imaging, bTFE sequences, EPI and diffusion-weighted
images.
There is a single living intrauterine gestation in cephalic position.
Appropriate cardiac motion is documented.
The fetus is phenotypically gender.
The placenta is location/previa. Multiple sequences do/do not
confirm any T2 low signal bands or foci of hemorrhage that extend
from the uterine surface toward the amniotic side of the placenta.
There are no intraplacental vessels larger than 5 mm. There is no
asymmetric placental bulging, either focal of generalized in the
LUS. There is no? indication that there is placental tissue outside
the confines of the uterus.
Risk factors for placental signal abnormalities:
Hx of tobacco use
+
Current tobacco use +
Prior uterine surgery c-section
DM + (gestational)
+
There is a normal volume of amniotic fluid.
There is a three vessel cord.
The cervix is long and closed.
The MR findings in the fetus reveal no abnormality, though
sequences have not been tailored on this examination specifically
to the fetus.
IMPRESSION:
1. previa/invasion?
2. No fetal abnormality identified.
END OF IMPRESSION:
Fetal MR for Skeletal Dysplasia
Referring MD:
Clinical indication:
Comparison is with complete obstetric ultrasound performed
today.
Best estimate of gestational age is 20w0d.
The MR study was performed without sedation or contrast after
informed consent was obtained. Sequences after bFFE localizers
consist primarily of T2-weighted single shot imaging with
additional bFFE images.
Data was additionally manipulated to create a virtual 3 dimensional
image set for the calculation of fetal lung volumes. The key images
from this processing were added to the exam. This information is
essential for the proper prenatal counseling and clinical care of the
fetus by the fetal care team.
There is a single living intrauterine gestation in vertex position.
Appropriate fetal limb and cardiac motion is documented.
The fetus is phenotypically female.
The placenta is ventral and away from the cervical os.
There is a normal volume of amniotic fluid.
There is a three vessel cord.
The cervix is long and closed.
There is no periuterine abnormality identified.
The MR findings reveal
total fetal lung volume (TFLV) =
O/E TFLV =
No other fetal abnormality is detected.
IMPRESSION:
Given the findings above, this is a lethal skeletal dysplasia. The
patient may benefit from a consultation with neonatology for an
appropriate perinatal plan of care.
END OF IMPRESSION:
Fetal MR report – twins
Referring MD:
Clinical History: CDH in one twin
Comparison is with complete obstetrical ultrasound performed
today.
The MR study was performed without sedation or contrast after
informed consent was obtained. Sequences after bFFE localizers
consist primarily of T2-weighted single shot imaging with
additional bFFE T1-weighted images.
There is a monochorionic diamniotic twin living intrauterine
gestation.
The cervix is long and closed.
There is no periuterine abnormality identified.
Fetus A
Appropriate limb and cardiac motion
Gender: phenotypically male
Placenta: ventral
Lie: cephalic
Amniotic fluid: normal
Cord: 3 vessel
Best overall assessment of gestational age by ultrasound is
determined to be weeks days.
MR anatomic evaluation in Fetus A shows the fetus is normal for
gestational age.
Fetus B
Appropriate limb and cardiac motion verified.
Gender: phenotypically male
Placenta: dorsal
Lie: variable
Amniotic fluid: normal
Cord: 3 vessel
Best overall assessment of gestational age by ultrasound is
determined to be weeks days.
The MR findings in fetus B reveal a small/large right/left
intrapleural/mediastinal hernia with
liver/bowel/stomach/spleen/kidney within the right/left chest. There
is consequent mass effect and mediastinal shift to the left/right.
Except for the position, the heart is unremarkable. There is no
evidence of pericardial effusion, or any other evidence of hydrops.
LHR
= 1
O/E LHR
= 2
MR right lung volume = 3
MR left lung volume = 4
TFLV
=5
O/E TFLV
= 6
IMPRESSION:
Fetus A: Normal
Fetus B: CDH
Based on the findings described above, the patient may benefit
from consultations with pediatric surgery and neonatology.
END OF IMPRESSION:
Fetal MR for posterior fossa DW spectrum lesion
Referring MD:
Clinical indication:
Comparison is with complete obstetric sonography performed
today.
Best overall assessment of gestational age is determined to be
weeks days.
The MR study was performed without sedation or contrast after
informed consent was obtained. Sequences after BFFE localizers
consist primarily of T2-weighted single shot imaging with
additional bFFE images.
There is a single living intrauterine gestation in vertex position.
Appropriate fetal limb and cardiac motion is documented.
The fetus is phenotypically female.
The placenta is to the right and away from the cervical os.
There is a normal volume of amniotic fluid.
There is a three vessel cord. The cervix is long and closed.
The MR findings in the fetus reveal inferior cerebellar vermian
dorsal rotation, with a mildly enlarged fourth ventricle and cisterna
magna. However, the formation of the vermis is normal, with an
acute fastigial point and a normal primary fissure. No other
abnormalities are identified. For example, there is no evidence of
callosal agenesis, migrational anomaly or hydrocephalus.
IMPRESSION:
Fetal inferior vermian rotation abnormality from a Blake's pouch
cyst, without hydrocephalus.
Based on the findings described above, the patient may benefit
from consultations with pediatric neurology and neurosurgery.
END OF IMPRESSION: