Fetal Magnetic Resonance Imaging Enhances Detection of Spinal Cord Anomalies in Patients With Sonographically Detected Bony Anomalies of the Spine

Abstract

Although fetal magnetic resonance imaging (MRI) is being increasingly used to evaluate sonographically suspected abnormalities, its utility in the evaluation of the spinal canal is not well studied. Because it is not susceptible to the limitations of fetal position, oligohydramnios, and shadowing from bony structures, we hypothesize that fetal MRI is better suited to assess the contents of the spinal canal compared with prenatal sonography. The purpose of this investigation was to determine whether fetal MRI could detect spinal abnormalities in cases in which they had not been originally suspected on prenatal sonography. Fetal spine MR images were retrospectively reviewed over a 42-month period. Corresponding sonographic images were then rereviewed to determine whether there were findings in retrospect that might have suggested the cord abnormalities. Cases of myelomeningocele were counted as a spinal cord abnormality only if fetal MRI showed a cord anomaly other than the myelomeningocele. Of 33 cases referred for bony anomalies of the spine, fetal MRI showed additional abnormalities involving the spinal cord in 3 patients. These included diastematomyelia in 2 cases and segmental spinal dysgenesis in the third case. One case of diastematomyelia occurred in association with a lumbosacral myelomeningocele. The spinal cord anomalies were not visible on any of the prenatal sonograms, even in retrospect. Additional spinal cord anomalies were detected in 10% of cases reviewed. Fetal MRI can be useful in assessing the spinal cord in fetuses with bony spinal anomalies. Our findings suggest that fetuses with sonographically diagnosed bony abnormalities of the spine may benefit from further evaluation with fetal MRI.