Quickly Obtained Magnetic Resonance Localizer Image in the Diagnosis of Anencephaly

Abstract

A 32-year-old and 32-week pregnant woman, gravida 6 parity 4, was admitted to obstetric clinic with complaints of eyes swelling for one week. Her physical examination and vital signs were normal except mildly bilateral eyelid swelling. Then the patient referred to the radiology department for first obstetric ultrasound (US) examination. Transabdominal obstetric US examination carried out to the patient. The US of fetus demonstrated absence of cranial bones and brain tissue and ranging amniotic fluid above the orbits (Figure 1). To confirm the sonographic diagnose patient underwent to the magnetic resonance imaging (MRI). A few minutes later only the localizer images was sufficient to definite the diagnose. The fast coronal localizer or scout magnetic resonance images demonstrated an absent skull consistent with anencephaly (Figure 2). The patient referred to the obstetrics and gynecology clinic again to terminate the gestation. Anencephaly is an embryological malformation of the central nervous system characterized by the lack of the brain and cranial vault. According to embryological view, anencephaly rise from a breakdown in the neural tube shutting. It is a quite rare anomaly one in about 20.000 birth (1). Etiology is not very apparent. Potential causes comprise some toxins and low intake of folic acid by the woman during pregnancy period. Even though sonography remains the primary imaging technique for assessing the fetal anomaly. Some significant limitations exist in the sonographic prenatal diagnosis especially some brain disorders. These limitations are, largely due to obscuration of portions of fetal intracranial anatomy caused by reverberative artifacts of the bony calvarium, engagement of the fetal head deep in the maternal pelvis and to the low sensitivity of fetal sonography to some brain malformations. Sonographic evaluation of the fetal head and spine can also be obstructed by oligohydramnios and maternal body habitus (2). Eur J Gen Med 2015; 12(4):367-368