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Magnetic resonance imaging of the fetal lung: a pictorial essay

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Abstract

Ultrasound, which is now a widely available and generally accepted, low-cost technique with real-time properties, is the screening investigation of choice in fetal medicine. However, enthusiasm for fetal prenatal magnetic resonance imaging (MRI) is rising, because of the absence of known biological risks, the increasing ease of performing of fetal MRI and the superb contrast resolution provided. Over the last 10 years, the technology has advanced dramatically. Fast imaging sequences have allowed better MRI visualization of the unborn patient than ever before. As a consequence, experience with fetal MRI is gradually expanding. We are beginning to appreciate the clinical conditions where fetal MRI can complement the ultrasound findings. Apart from the central nervous system, MRI of the fetal lung has received the most attention. Fetal MRI can be used to assess thoracic structural anomalies, lung development as well as maturation. The introduction of fetal therapy for severe lung hypoplasia, associated with congenital diaphragmatic hernia (CDH), has recently boosted the application. This review aims to highlight MRI techniques used to image the lungs of the unborn child and to point out their strengths and limitations in specific conditions.

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References

  1. Kotecha S (2000) Lung growth for beginners. Paediatr Respir Rev 1:308–313

    Article  CAS  PubMed  Google Scholar 

  2. Kasprian G, Balassy C, Brugger PC, Prayer D (2006) MRI of normal and pathological fetal lung development. Eur J Radiol 57:261–270

    Article  PubMed  Google Scholar 

  3. Cannie M, Jani J, Dymarkowski S, Deprest J (2006) Fetal magnetic resonance imaging: luxury or necessity? Ultrasound Obstet Gynecol 27:471–476

    Article  CAS  PubMed  Google Scholar 

  4. Cannie M, Jani J, Dymarkowski S, Levine D, Deprest J (2006) Reply. Ultrasound Obstet Gynecol 28:860–861

    Article  Google Scholar 

  5. Brewerton LJ, Chari RS, Liang Y, Bhargava R (2005) Fetal lung-to-liver signal intensity ratio at MR imaging: development of a normal scale and possible role in predicting pulmonary hypoplasia in utero. Radiology 235:1005–1010

    Article  PubMed  Google Scholar 

  6. Kuwashima S, Nishimura G, Iimura F, Kohno T, Watanabe H, Kohno A, Fujioka M (2001) Low-intensity fetal lungs on MRI may suggest the diagnosis of pulmonary hypoplasia. Pediatr Radiol 31:669–672

    Article  CAS  PubMed  Google Scholar 

  7. Brugger PC, Stuhr F, Lindner C, Prayer D (2006) Methods of fetal MR: beyond T2-weighted imaging. Eur J Radiol 57:172–181

    Article  PubMed  Google Scholar 

  8. Prayer D, Brugger PC, Prayer L (2004) Fetal MRI: techniques and protocols. Pediatr Radiol 34:685–693

    Article  PubMed  Google Scholar 

  9. Levine D, Smith AS, McKenzie C (2003) Tips and tricks of fetal MR imaging. Radiol Clin North Am 41:729–745

    Article  PubMed  Google Scholar 

  10. Duerk JL, Lewin JS, Wendt M, Petersilge C (1998) Remember true FISP? A high SNR, near 1-second imaging method for T2-like contrast in interventional MRI at.2 T. J Magn Reson Imaging 8:203–208

    Article  CAS  PubMed  Google Scholar 

  11. Chung HW, Chen CY, Zimmerman RA, Lee KW, Lee CC, Chin SC (2000) T2-Weighted fast MR imaging with true FISP versus HASTE: comparative efficacy in the evaluation of normal fetal brain maturation. AJR Am J Roentgenol 175:1375–1380

    CAS  PubMed  Google Scholar 

  12. Zizka J, Elias P, Hodik K, Tintera J, Juttnerova V, Belobradek Z, Klzo L (2006) Liver, meconium, haemorrhage: the value of T1-weighted images in fetal MRI. Pediatr Radiol 36:792–801

    Article  PubMed  Google Scholar 

  13. Righini A, Bianchini E, Parazzini C, Gementi P, Ramenghi L, Baldoli C, Nicolini U, Mosca F, Triulzi F (2003) Apparent diffusion coefficient determination in normal fetal brain: a prenatal MR imaging study. AJNR Am J Neuroradiol 24:799–804

    PubMed  Google Scholar 

  14. Moore RJ, Strachan B, Tyler DJ, Baker PN, Gowland PA (2001) In vivo diffusion measurements as an indication of fetal lung maturation using echo planar imaging at 0.5T. Magn Reson Med 45:247–253

    Article  CAS  PubMed  Google Scholar 

  15. Fenton BW, Lin CS, Ascher S, Macedonia C (2000) Magnetic resonance spectroscopy to detect lecithin in amniotic fluid and fetal lung. Obstet Gynecol 95:457–460

    Article  CAS  PubMed  Google Scholar 

  16. Fenton BW, Lin CS, Seydel F, Macedonia C (1998) Lecithin can be detected by volume-selected proton MR spectroscopy using a 1.5 T whole body scanner: a potentially non-invasive method for the prenatal assessment of fetal lung maturity. Prenat Diagn 18:1263–1266

    Article  CAS  PubMed  Google Scholar 

  17. Greenough A (2000) Factors adversely affecting lung growth. Paediatr Respir Rev 1:314–320

    Article  CAS  PubMed  Google Scholar 

  18. Levine D (2005) Atlas of Fetal MRI. Taylor & Francis Group

  19. Levine D, Barnewolt CE, Mehta TS, Trop I, Estroff J, Wong G (2003) Fetal thoracic abnormalities: MR imaging. Radiology 228:379–388

    Article  PubMed  Google Scholar 

  20. Coakley FV, Hricak H, Filly RA, Barkovich AJ, Harrison MR (1999) Complex fetal disorders: effect of MR imaging on management-preliminary clinical experience. Radiology 213:691–696

    CAS  PubMed  Google Scholar 

  21. Hubbard AM, Adzick NS, Crombleholme TM, Coleman BG, Howell LJ, Hasselgrove JC, Mahboubi S (1999) Congenital chest lesions: diagnosis and characterization with prenatal MR imaging. Radiology 212:43–48

    CAS  PubMed  Google Scholar 

  22. Graham G, Devine PC (2005) Antenatal diagnosis of congenital diaphragmatic hernia. Semin Perinatol 29:69–76

    Article  PubMed  Google Scholar 

  23. Metkus AP, Filly RA, Stringer MD, Harrison MR, Adzick NS (1996) Sonographic predictors of survival in fetal diaphragmatic hernia. J Pediatr Surg 31:148–151

    Article  CAS  PubMed  Google Scholar 

  24. Lipshutz GS, Albanese CT, Feldstein VA, Jennings RW, Housley HT, Beech R, Farrell JA, Harrison MR (1997) Prospective analysis of lung-to-head ratio predicts survival for patients with prenatally diagnosed congenital diaphragmatic hernia. J Pediatr Surg 32:1634–1636

    Article  CAS  PubMed  Google Scholar 

  25. Jani J, Keller RL, Benachi A, Nicolaides KH, Favre R, Gratacos E, Laudy J, Eisenberg V, Eggink A, Vaast P, Deprest J, Antenatal-CDH-Registry Group (2006) Prenatal prediction of survival in isolated left-sided diaphragmatic hernia. Ultrasound Obstet Gynaecol 27:18–22

    Article  CAS  Google Scholar 

  26. Kalache KD, Espinoza J, Chaiworapongsa T, Londono J, Schoen ML, Treadwell MC, Lee W, Romero R (2003) Three-dimensional ultrasound fetal lung volume measurement: a systematic study comparing the multiplanar method with the rotational (VOCAL) technique. Ultrasound Obstet Gynecol 21:111–118

    Article  CAS  PubMed  Google Scholar 

  27. Rypens F, Metens T, Rocourt N, Sonigo P, Brunelle F, Quere MP, Guibaud L, Maugey-Laulom B, Durand C, Avni FE, Eurin D (2001) Fetal lung volume: estimation at MR imaging-initial results. Radiology 219:236–241

    CAS  PubMed  Google Scholar 

  28. Coakley FV, Lopoo JB, Lu Y, Hricak H, Albanese CT, Harrison MR, Filly RA (2000) Normal and hypoplastic fetal lungs: volumetric assessment with prenatal single-shot rapid acquisition with relaxation enhancement MR imaging. Radiology 216:107–111

    CAS  PubMed  Google Scholar 

  29. Jani J, Peralta CFA, Ruano R, Benachi A, Done E, Nicolaides KH, Deprest J (2007) Comparison of fetal lung area to head circumference ratio with lung volume in the prediction of postnatal outcome in diaphragmatic hernia. Ultrasound Obstet Gynecol 30:850–854

    Article  CAS  PubMed  Google Scholar 

  30. Jani J, Cannie M, Done E, Van Mieghem T, Van Schoubroeck D, Gucciardo L, Dymarkowski S, Deprest J (2007) Relationship between lung area at ultrasound and lung volume assessment with Magnetic Resonance Imaging in isolated congenital diaphragmatic hernia. Ultrasound Obstet Gynecol 30:855–860

    Article  CAS  PubMed  Google Scholar 

  31. Jani JC, Cannie M, Peralta CF, Deprest JA, Nicolaides KH, Dymarkowski S (2007) Lung volumes in fetuses with congenital diaphragmatic hernia: comparison of 3D US and MR imaging assessments. Radiology 244:575–582

    Article  PubMed  Google Scholar 

  32. Cannie M, Jani JC, De Keyzer F, Devlieger R, Van Schoubroeck D, Witters I, Marchal G, Dymarkowski S, Deprest JA (2006) Fetal body volume: use at MR imaging to quantify relative lung volume in fetuses suspected of having pulmonary hypoplasia. Radiology 241:847–853

    Article  PubMed  Google Scholar 

  33. Osada H, Kaku K, Masuda K, Iitsuka Y, Seki K, Sekiya S (2004) Quantitative and qualitative evaluations of fetal lung with MR imaging. Radiology 231:887–892

    Article  PubMed  Google Scholar 

  34. Keller TM, Rake A, Michel SC, Seifert B, Wisser J, Marincek B, Kubik-Huch RA (2004) MR assessment of fetal lung development using lung volumes and signal intensities. Eur Radiol 14:984–989

    Article  PubMed  Google Scholar 

  35. Avni F (2002) Perinatal imaging: from ultrasound to MR Imaging. Springer

  36. Bromley B, Parad R, Estroff JA, Benacerraf BR (1995) Fetal lung masses: prenatal course and outcome. J Ultrasound Med 14:927–936

    CAS  PubMed  Google Scholar 

  37. Stocker JT, Madewell JE, Drake RM (1977) Congenital cystic adenomatoid malformation of the lung. Classification and morphologic spectrum. Hum Pathol 8:155–171

    CAS  Google Scholar 

  38. De Santis M, Masini L, Noia G, Cavaliere AF, Oliva N, Caruso A (2000) Congenital cystic adenomatoid malformation of the lung: antenatal ultrasound findings and fetal-neonatal outcome. Fifteen years of experience. Fetal Diagn Ther 15:246–250

    Article  PubMed  Google Scholar 

  39. Tawil MI, Pilling DW (2005) Congenital cystic adenomatoid malformation: is there a difference between the antenatally and postnatally diagnosed cases? Pediatr Radiol 35:79–84

    Article  PubMed  Google Scholar 

  40. Deprest J, Jani J, Lewi L, Ochsenbein-Kolble N, Cannie M, Done E, Roubliova X, Van Mieghem T, Debeer A, Debuck F, Sbragia L, Toelen J, Devlieger R, Lewi P, Van de Velde M (2006) Fetoscopic surgery: encouraged by clinical experience and boosted by instrument innovation. Semin Fetal Neonatal Med 11:398–412

    Article  PubMed  Google Scholar 

  41. MacGillivray TE, Harrison MR, Goldstein RB, Adzick NS (1993) Disappearing fetal lung lesions. J Pediatr Surg 28:1321–1324

    Article  CAS  PubMed  Google Scholar 

  42. Winters WD, Effmann EL, Nghiem HV, Nyberg DA (1997) Disappearing fetal lung masses: importance of postnatal imaging studies. Pediatr Radiol 27:535–539

    Article  CAS  PubMed  Google Scholar 

  43. Winters WD, Effmann EL (2001) Congenital masses of the lung: prenatal and postnatal imaging evaluation. J Thorac Imaging 16:196–206

    Article  CAS  PubMed  Google Scholar 

  44. Stanton M, Davenport M (2006) Management of congenital lung lesions. Early Hum Dev 82:289–295

    Article  PubMed  Google Scholar 

  45. Srikanth MS, Ford EG, Stanley P, Mahour GH (1992) Communicating bronchopulmonary foregut malformations: classification and embryogenesis. J Pediatr Surg 27:732–736

    Article  CAS  PubMed  Google Scholar 

  46. Marwan A, Crombleholme TM (2006) The EXIT procedure: principles, pitfalls, and progress. Semin Pediatr Surg 15:107–115

    Article  PubMed  Google Scholar 

  47. Dolkart LA, Reimers FT, Helmuth WV, Porte MA, Eisinger G (1992) Antenatal diagnosis of pulmonary sequestration: a review. Obstet Gynecol Surv 47:515–520

    Article  CAS  PubMed  Google Scholar 

  48. Hernanz-Schulman M (1993) Cysts and cystlike lesions of the lung. Radiol Clin North Am 31:631–649

    CAS  PubMed  Google Scholar 

  49. Hubbard AM, Crombleholme TM (1998) Anomalies and malformations affecting the fetal/neonatal chest. Semin Roentgenol 33:117–125

    Article  CAS  PubMed  Google Scholar 

  50. Smith RP, Illanes S, Denbow ML, Soothill PW (2005) Outcome of fetal pleural effusions treated by thoracoamniotic shunting. Ultrasound Obstet Gynecol 26:63–66

    Article  CAS  PubMed  Google Scholar 

  51. Laudy JA, Wladimiroff JW (2000) The fetal lung. 2: Pulmonary hypoplasia. Ultrasound Obstet Gynecol 16:482–494

    Article  CAS  PubMed  Google Scholar 

  52. Mercer BM (2005) Preterm premature rupture of the membranes: current approaches to evaluation and management. Obstet Gynecol Clin North Am 32:411–428

    Article  PubMed  Google Scholar 

  53. Nimrod C, Varela-Gittings F, Machin G, Campbell D, Wesenberg R (1984) The effect of very prolonged membrane rupture on fetal development. Am J Obstet Gynecol 148:540–543

    CAS  PubMed  Google Scholar 

  54. Thibeault DW, Beatty EC Jr, Hall RT, Bowen SK, O’Neill DH (1985) Neonatal pulmonary hypoplasia with premature rupture of fetal membranes and oligohydramnios. J Pediatr 107:273–277

    Article  CAS  PubMed  Google Scholar 

  55. van Dongen PW, Antonissen J, Jongsma HW, Sporken JM, Hein PR (1987) Lethal lung hypoplasia in infants after prolonged rupture of membranes. Eur J Obstet Gynecol Reprod Biol 25:287–292

    Article  PubMed  Google Scholar 

  56. Rotschild A, Ling EW, Puterman ML, Farquharson D (1990) Neonatal outcome after prolonged preterm rupture of the membranes. Am J Obstet Gynecol 162:46–52

    CAS  PubMed  Google Scholar 

  57. McIntosh N, Harrison A (1994) Prolonged premature rupture of membranes in the preterm infant: a 7 year study. Eur J Obstet Gynecol Reprod Biol 57:1–6

    Article  CAS  PubMed  Google Scholar 

  58. Yoshimura S, Masuzaki H, Gotoh H, Fukuda H, Ishimaru T (1996) Ultrasonographic prediction of lethal pulmonary hypoplasia: comparison of eight different ultrasonographic parameters. Am J Obstet Gynecol 175:477–483

    Article  CAS  PubMed  Google Scholar 

  59. Lauria MR, Gonik B, Romero R (1995) Pulmonary hypoplasia: pathogenesis, diagnosis, and antenatal prediction. Obstet Gynecol 86:466–475

    Article  CAS  PubMed  Google Scholar 

  60. D’Alton M, Mercer B, Riddick E, Dudley D (1992) Serial thoracic versus abdominal circumference ratios for the prediction of pulmonary hypoplasia in premature rupture of the membranes remote from term. Am J Obstet Gynecol 166:658–663

    CAS  PubMed  Google Scholar 

  61. Vintzileos AM, Campbell WA, Rodis JF, Nochimson DJ, Pinette MG, Petrikovsky BM (1989) Comparison of six different ultrasonographic methods for predicting lethal fetal pulmonary hypoplasia. Am J Obstet Gynecol 161:606–612

    CAS  PubMed  Google Scholar 

  62. Poutamo J, Vanninen R, Partanen K, Kirkinen P (2000) Diagnosing fetal urinary tract abnormalities: benefits of MRI compared to ultrasonography. Acta Obstet Gynecol Scand 79:65–71

    Article  CAS  PubMed  Google Scholar 

  63. Cassart M, Massez A, Metens T, Rypens F, Lambot MA, Hall M, Avni FE (2004) Complementary role of MRI after sonography in assessing bilateral urinary tract anomalies in the fetus. AJR Am J Roentgenol 182:689–695

    PubMed  Google Scholar 

  64. Wigglesworth JS, Desai R (1979) Effect on lung growth of cervical cord section in the rabbit fetus. Early Hum Dev 3:51–65

    Article  CAS  PubMed  Google Scholar 

  65. Gorincour G, Bouvenot J, Mourot MG, Sonigo P, Chaumoitre K, Garel C, Guibaud L, Rypens F, Avni F, Cassart M, Maugey-Laulom B, Bourliere-Najean B, Brunelle F, Durand C, Eurin D (2005) Prenatal prognosis of congenital diaphragmatic hernia using magnetic resonance imaging measurement of fetal lung volume. Ultrasound Obstet Gynecol 26:738–744

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

We thank Dr. Nicola Flack for her help in manuscript editing.

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Authors and Affiliations

  1. Department of Radiology, University Hospitals Leuven, Leuven, Belgium

    M. Cannie, F. De Keyzer, F. Van Kerkhove, J. Meersschaert & S. Dymarkowski

  2. Department Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium

    J. Jani, L. Lewi & J. Deprest

  3. Department of Radiology, UZ Gasthuisberg, 3000, Leuven, Belgium

    S. Dymarkowski

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  1. M. Cannie
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  2. J. Jani
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  3. F. De Keyzer
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  5. J. Meersschaert
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  6. L. Lewi
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  8. S. Dymarkowski
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Correspondence to S. Dymarkowski.

Additional information

M. Cannie was partly supported by the unconditional research grant “Prof. Em. A. L. Baert, Siemens Medical Solutions” (EMF-LSSMS1-P3610). The European Commission supported J. Jani with a grant within the 5th Framework Programme (QLG1 CT2002 01632; EuroTwin2Twin).

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Cannie, M., Jani, J., De Keyzer, F. et al. Magnetic resonance imaging of the fetal lung: a pictorial essay. Eur Radiol 18, 1364–1374 (2008). https://doi.org/10.1007/s00330-008-0877-1

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  • DOI: https://doi.org/10.1007/s00330-008-0877-1

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