Role of Fetal MRI for Suspected Anomalies of the Posterior F
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Posterior fossa (PF) anomalies can be diagnostic dilemmas during the fetal period. The prognosis for different diagnosis of the PF varies widely. A Study was conducted to determine whether fetal MRI (feMRI) and prenatal neurology consultation lead to alternate diagnoses for maternal-fetal dyads referred due to concern for a fetal PF anomaly and to determine how often the pre- and postnatal diagnosis differed.

This is a retrospective study of cases referred to the Prenatal Pediatrics Institute at Children’s National Hospital from January 2012 to June 2018 due to concern for PF anomaly. Cases were scored for change in prognosis based upon clinical and feMRI report. Postnatal imaging was compared with prenatal imaging, where available.

In total, 180 cases were referred for fetal PF anomalies based on outside obstetric ultrasound, underwent feMRI and had a neurology consultation. FeMRI and neurology consultation resulted in a change in fetal prognosis in 70% of cases.
-The most common referral diagnosis in the cohort was Dandy-Walker continuum, but it was not often confirmed by feMRI.
-In complex cases, PF diagnosis and prognosis determined by feMRI impacted choices regarding pregnancy management.
-Postnatal imaging was obtained in 57 live-born infants. Fetal and postnatal prognoses were similar in 60% of cases.

Fetal diagnosis impacts pregnancy management decisions. Fetal-postnatal imaging agreement was 60% overall, highlighting the conundrum of balancing the timing of feMRI to provide the most accurate diagnosis in time to make pregnancy management decisions regarding suspected abnormalities of the posterior fossa.