Findings and differential diagnosis of fetal intracranial haemorrhage and fetal ischaemic brain injury: what is the role of fetal MRI?

Abstract

Ventriculomegaly (VM) is a non-specific finding on fetal imaging. Identification of the specific aetiology is important, as it affects prognosis and may even change the course of current or future pregnancies. In this review, we will focus on the application of fetal MRI to demonstrate intracranial haemorrhage and ischaemic brain injury as opposed to other causes of VM. MRI is able to identify the specific aetiology of VM with much more sensitivity and specificity than ultrasound and should be considered whenever VM is identified on obstetric ultrasound. Advances in both fetal and neonatal MRI have the potential to shed further light on mechanisms of brain injury and the impact of chronic hypoxia; such information may guide future interventions.

Fetal intracranial hemorrhage: role of fetal MRI

“…Moreover, while diffusion‐weighted and echo‐planar MRI sequences are currently part of our clinical imaging protocol, they were not available for all the fetal MRI exams of the study period. Thus, our study did not include data derived by diffusion‐weighted, echo‐planar, or 3‐T MRI that could potentially increase the detection of ICH …”

Pontine Tegmental Cap Dysplasia and Challenges in Facial Reconstructive Surgery

“…While there are no dedicated reports of fetal MRI and PTCD, Glenn et al (2012) reported that fetal MR imaging has the highest sensitivity and specificity for cortical malformations, and Limperopoulos et al (2008) showed that 60% of prenatal diagnosis of posterior fossa pathology on MRI was confirmed postnatally. Although ultrasonography remains the most common prenatal imaging modality, fetal MRI can provide additional diagnostic information especially in relation to central nervous system conditions, such as intracranial hemorrhage, ischemic brain injury, intracranial tumors and cysts, hydranencephaly, schizencephaly, severe hydrocephalus, and posterior fossa abnormalities (Putbrese and Kennedy, 2016; Sefidbakht et al, 2016). Some limitations include fetal motion and gestational age (Putbrese and Kennedy, 2016).…”

“…Although ultrasonography remains the most common prenatal imaging modality, fetal MRI can provide additional diagnostic information especially in relation to central nervous system conditions, such as intracranial hemorrhage, ischemic brain injury, intracranial tumors and cysts, hydranencephaly, schizencephaly, severe hydrocephalus, and posterior fossa abnormalities (Putbrese and Kennedy, 2016; Sefidbakht et al, 2016). Some limitations include fetal motion and gestational age (Putbrese and Kennedy, 2016). Increased accuracy of fetal MRI is obtained when performed after 24 weeks’ gestation when the fetal structures are larger (Glenn et al, 2012).…”

Fetal MRI for dummies: what the fetal medicine specialist should know about acquisitions and sequences

“…EPI and GE images are extremely useful in detecting regions of hemorrhage While acute hemorrhage can be accurately detected on T1W and T2W, hemosiderin deposits may be difficult to visualize . This becomes particularly important in the cases of ventriculomegaly and hydrocephalus, where the detection of hemosiderin deposits in the ventricular lining is diagnostic of past hemorrhage and helps exclude other pathologies and better counsel the parents.…”