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OBJECTIVE-The first objective of our study was to describe the prevalence and spectrum of posterior fossa anomalies over 5 years in a major fetal care center where the referral diagnosis (by fetal sonography) was investigated by fetal MRI and, if confirmed, by postnatal MRI if possible. The second objective was to assess the accuracy with which fetal MRI predicts postnatal MRI findings in this population. MATERIALS AND METHODS-We retrospectively identified all cases of suspected fetal posterior fossa anomalies referred to our center from 2002 through 2006. We reviewed maternal, fetal, neonatal, and follow-up records of all cases and fetal and early postnatal imaging studies.RESUlTS-Of the 90 cases of suspected fetal posterior fossa anomalies (by fetal sonography) referred over the study period, 60 (67%) were confirmed by fetal MRI. Of 42 live-born infants, 39 (93%) underwent postnatal MRI. There was complete agreement in fetal and postnatal MRI diagnoses in 23 infants (59%). In 16 cases (41%), fetal and postnatal MRI diagnoses disagreed; postnatal MRI excluded fetal MRI diagnoses in six cases (15%) and revealed additional anomalies in 10 cases (26%).CONClUSION-Although a valuable adjunct to fetal sonography in cases of suspected posterior fossa anomaly, current fetal MRI, particularly in early gestation, has limitations in accurately predicting postnatal MRI abnormalities. Advancing the accuracy of MRI for the diagnosis of posterior fossa anomalies will require greater understanding of normal brain development and improved tissue resolution of fetal MRI. During the interim, our findings strongly support the need for postnatal MRI follow-up in cases with suspected posterior fossa anomalies by fetal MRI. Posterior fossa malformations are among the most common brain anomalies identified by current fetal imaging techniques. Advances in MRI during fetal and early postnatal life continue to provide important insights into normal and abnormal development of the cerebellum and brainstem [1][2][3][4][5][6]. Despite the rapid progress in fetal imaging, the prenatal diagnosis of posterior fossa dysgenesis remains challenging due to both false-positive and false-negative diagnoses [7][8][9][10][11][12][13]. As a result, a variety of classification schemes have been proposed for posterior fossa anomalies 14-17] without any scheme receiving widespread acceptance to date. KeywordsAbnormalities of posterior fossa development can, in general, be divided into those in a small posterior fossa with "crowding" of its contents (e.g., Chiari's malformations) versus those occurring in a normal or enlarged posterior fossa. The latter category, which is the focus of this study, may be further subcategorized into anomalies in a posterior fossa with normal fluid spaces versus those associated with enlarged (relatively or absolutely) posterior fossa fluid spaces.The primary reason for performing fetal imaging is to gather accurate information about fetal structure on which to base reliable counseling. This counseling to parents is i...

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Objective: To determine whether any common maternal-fetal variable has prenatal predictive value of prosthetic repair in congenital diaphragmatic hernia. Methods: This was a 5-year single-center retrospective review of fetal congenital diaphragmatic hernia referrals. Multiple prenatal variables were correlated with the need for a prosthetic repair. Statistical analyses were by Fisher’s exact and Mann-Whitney U-tests, as appropriate (p < 0.05). Results: Fetal liver position was a predictor of prosthetic repair. The presence or absence of liver herniation was correlated with prosthetic repair rates of 83.3 and 23.1%, respectively (p < 0.001). All patients with moderate/severe liver herniation required a prosthetic patch. Conclusion: Liver herniation has prenatal predictive value for the need for prosthetic repair in congenital diaphragmatic hernia. This finding should be valuable during prenatal counseling for clinical trials of engineered diaphragmatic repair.