Effectiveness of magnetic resonance imaging in prenatal diagnosis of fetal anomalies

AIM: The aim of this study is to investigate the effectiveness of MRI in prenatal evaluation in the detection of fetal anomalies, determination of prognosis, detection and management of intrauterine and postnatal surgical requirements. MATERIAL and METHODS: With the approval of the Ethics Committee of Istanbul University Cerrahpaşa Medical Faculty, numbered E-83045809-604.01-897382 and dated 23.01.2024, a retrospective evaluation was conducted on pregnant women who applied to the Istanbul University Cerrahpaşa Medical Faculty Department of Obstetrics and Gynecology between 2016-2024, were found to have fetal anomalies during their follow-up, and underwent fetal magnetic resonance imaging (MRI) during the antenatal period. A total of 198 cases were included in the study. The patients' data were examined from the hospital information system and patient files. Patients whose complete data could not be accessed were contacted by phone. The patients' data were systematically recorded. IBM SPSS Statistics 27.0 was used for statistical analysis RESULTS: The mean age of the cases was found to be 29.9 ± 5.7 (17-44). The gestational week (GW) at which the cases were diagnosed by ultrasound was 24 ± 5.2 (12-38) weeks, and the gestational week at which they were diagnosed by MRI was 27.2 ± 4.6 (17-38) weeks. In CNS anomalies (n:142), the correlation between USG/MRI in cases with isolated mild ventriculomegaly was found to be 100%, 100% in isolated severe ventriculomegaly, 92% in ventriculomegaly with associated NCS anomalies, 100% in posterior fossa anomalies, 73% in NTD, 100% in migration anomalies, 100% in intracranial mass/thrombosis/hemorrhages, 85% in midline anomalies, and 29% in multiple anomalies. The consistency between prenatal imaging and postnatal results was 100% in cases with isolated mild ventriculomegaly, 100% in isolated severe ventriculomegaly, 92% in ventriculomegaly with associated CNS anomalies, 93% in posterior fossa anomalies, 100% in NTD with USG and 73% with MRI, 100% in migration anomalies, 100% in intracranial mass/thrombosis/hemorrhages, 82% with USG and 97% with MRI in midline anomalies, and 100% with USG and 29% with MRI in multiple anomalies. In head and neck anomalies (n:4), the ultrasound/MRI correlation was found to be 100%, and the concordance between prenatal imaging and postnatal outcomes was 100%. In cardiac system anomalies (n:4), the ultrasound/MRI correlation was found to be 80%, and the concordance between prenatal imaging and postnatal outcomes was 71%. In respiratory system anomalies (n:16), the ultrasound/MRI correlation was found to be 94%, and the concordance between prenatal imaging and postnatal outcomes was 94%. In abdominal system anomalies (n:3), the ultrasound/MRI correlation was found to be 100%, and the concordance between prenatal imaging and postnatal outcomes was 100%. In genitourinary anomalies (n:7), the ultrasound/MRI correlation was found to be 86%, and the concordance between prenatal imaging and postnatal outcomes was 77%. In skeletal system anomalies (n:1), the ultrasound/MRI correlation was found to be 75%, and the concordance between prenatal imaging and postnatal outcomes was 100%. In multiple pregnancies (n:17), the ultrasound/MRI correlation was found to be 95%, and the concordance between prenatal imaging and postnatal outcomes was 100%. CONCLUSION: Currently, ultrasound (USG) continues to be the preferred method for screening. It has advantages over MRI in the first trimester, in the evaluation of fetal cardiac function, in the assessment of skeletal anomalies, and in the real-time observation of fetal behavior. MRI, on the other hand, provides additional contributions to the evaluation of CNS anomalies, determination of the degree of obstruction in pathologies causing obstruction, calculation of lung and liver volume and detection of additional anomalies. In light of the literature, it is considered that fetal MRI has significant contributions in cases where USG is insufficient, in the detection of additional anomalies, in planning intrauterine and postnatal surgical interventions, and in determining prognosis.