Abstract
Background
It has been described that both the colon and distal ileum present with a physiological hypersignal on T1-weighted sequences during the second and third trimesters of pregnancy because of their protein-rich meconium content, it was unclear whether the normal characteristics that have been described on fetal MRI can be applied to gastrointestinal (GI) obstructions.
Objective
To analyse the localisation value of T1 hypersignal within dilated bowel loops in fetuses with gastrointestinal tract obstruction.
Materials and methods
A retrospective 4-year multicentre study analysing cases of fetal GI obstruction in which MRI demonstrated T1 hypersignal content in the dilated loops. Data collected included gestational age (GA) at diagnosis, bowel appearance on US, CFTR gene mutations and amniotic levels of gastrointestinal enzymes. The suggested prenatal diagnosis was eventually compared to postnatal imaging and surgery.
Results
Eleven patients were included. The median GA at US diagnosis was 23 weeks (range 13–32). In eight cases there was a single dilated loop, while several segments were affected in three. The median GA at MRI was 29 weeks (range 23–35). One case presented with cystic fibrosis mutations. Final prenatally suspected diagnoses were distal ileal atresia or colon in nine cases and proximal atresia in two. Postnatal findings were proximal jejunal atresia in nine cases and meconium ileus in two. In five cases the surgical findings demonstrated short bowel syndrome.
Conclusion
In cases of fetal occlusion, T1 hypersignal should not be considered as a sign of distal ileal or colonic occlusion. The obstruction may be proximal, implying a risk of small bowel syndrome, which requires adequate parental counselling.
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Acknowledgments
We are very grateful to the members of the multidisciplinary team in Marseille who were so strongly involved in the management of these patients, especially Dr Alain Potier, Prof Pascal de Lagausie, Dr Marie-Pierre Bréchard and Dr Jean Cristofari from Saint-Joseph Hopital, Pr Nicole Philip and Pr Marc Gamerre. Many thanks to Gillian Xeridat for her English ‘adaptation’ of the manuscript.
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Colombani, M., Ferry, M., Garel, C. et al. Fetal gastrointestinal MRI: all that glitters in T1 is not necessarily colon. Pediatr Radiol 40, 1215–1221 (2010). https://doi.org/10.1007/s00247-009-1497-x
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DOI: https://doi.org/10.1007/s00247-009-1497-x