Postmortem MR Imaging of the Fetal and Stillborn Central Nervous System
Paul D. Griffithsa,
Dick Variendb,
Margaret Evansb,
Angharad Jonesa,
Iain D. Wilkinsona,
Martyn N. J. Paleya and
Elspeth Whitbya
a Section of Academic Radiology, University of Sheffield, Sheffield, UK
b Department of Pathology, Sheffield Children’s Hospital, Sheffield, UK
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FIG 1. A, Coronal and B, axial brain MR images in a spontaneously aborted 22-week fetus. The image quality was assessed as excellent and findings reported as normal, which agreed with the autopsy report. The dark structures (arrows) in the immediate periventricular regions are the germinal matrices. Migrating neurons are shown in cerebral hemispheres as gray matter signal intensity against the high signal intensity of the white matter.
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FIG 2. MR images of a fetus after therapeutic abortion at 18 weeks because of a sonographic diagnosis of alobar holoprosencephaly. Autopsy could not provide any information because of the poor state of the unfixed brain.
A, Axial and B, coronal brain MR images confirm the typical features of alobar holoprosencephaly: nonseparated cerebral hemispheres, holoventricle, and fused thalami. Note the single, poorly formed orbit (cyclopia) (arrow) and an azygous anterior cerebral artery (arrowheads).
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FIG 3. A, Sagittal spine and B, axial brain MR images in a 20-week fetus after a therapeutic abortion because of a sonographic diagnosis of myelomeningocele and Chiari II malformation. These findings were confirmed with postmortem MR imaging and autopsy. The spine MR image (A) shows a low thoracic myelomeningocele with an adjacent complicated fusion defect of the lower thoracic-upper lumbar vertebral bodies. There is also extensive syringohydromyelia. The cerebellar tonsils (arrow) are abnormally low (at C3), indicating a Chiari II abnormality, and images of the brain (not shown) confirmed the presence of a small posterior fossa. This brain MR image (B) shows ventriculomegaly and the "lemon-shaped" deformity recognized on sonograms in cases such as these.
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FIG 4. A, Axial and B, right parasagittal MR images in a 21-week fetus after therapeutic abortion performed on the basis of a parietal meningocele on sonograms. This was reported as such at autopsy. MR images show that there is also brain and ventricle in the abnormality (therefore, technically a meningoencephalocystocele). In addition, the MR images show an area of cortical dysplasia (arrow) in the right frontal lobe that was not reported at sonography or autopsy. This was confirmed at consensus review. Note the generalized reduction in volume of migrating neurons in the right cerebral hemisphere.
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AJNR - American Journal of Neuroradiology