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Jouzova A, Jouza M, Turek J, Gerychova R, Jezova M, Janku P, Hruban L. Sacrococcygeal teratoma - prognosis based on prenatal ultrasound diagnosis, single-center experience and literature review. BMC Pregnancy Childbirth 2025; 25:469. [PMID: 40269769 PMCID: PMC12016376 DOI: 10.1186/s12884-025-07494-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 03/19/2025] [Indexed: 04/25/2025] Open
Abstract
INTRODUCTION Sacrococcygeal teratoma (SCT) is the most common congenital tumor. The incidence of malignant types is rare but increases with late detection or in case of relapse. Prenatal diagnosis is based on ultrasound examination and magnetic resonance imaging (MRI). Since this is a rare congenital anomaly, we should report all cases to improve prenatal diagnosis and postnatal management. MATERIAL AND METHODS Retrospective analysis of sixteen cases of sacrococcygeal teratoma delivered and treated at the University Hospital Brno between 2005 and 2020. The following criteria were evaluated: gestational week of the primary diagnosis, exact description of ultrasound findings, pregnancy management, delivery mode, correlation of prenatal ultrasound with postnatal findings in the newborn, as well as the occurrence of early and late complications in newborns and children. RESULTS Out of sixteen cases, seven cases (43.8%) were indicated for pregnancy termination based on ultrasound findings, the parent's decision, and an estimation of an adverse pregnancy outcome. In nine cases (56.2%), the pregnancy continued and was ended by delivery. In one case, there was an early postnatal death of a newborn after birth in the 25th week of gestation. In eight cases, live fetuses were born in which the tumor was surgically removed between day 1 and 14 months after birth. There was a strong correlation between the tumor description made by prenatal ultrasound diagnosis and related severe complications in newborns. The incidence of severe early and late complications in ongoing pregnancies was very low-only one case of infection in the surgical wound requiring reoperation (12.5%) was described. In two patients (25%), a transient stoma establishment was necessary for secondary ileus. One case of recurrence of the disease at two years of age occurred, requiring the administration of chemotherapy (12.5%), and one patient has mild persistent urinary incontinence. CONCLUSION Sacrococcygeal teratoma is one of the rarest congenital malformations. A detailed prenatal ultrasound examination is essential to estimate the pregnancy prognosis. The most predictive ultrasound predictor of favorable early and late postnatal outcomes and long-term child development is the presence of cystic sacrococcygeal formation, the most common tumor type, and the absence of signs of cardiac failure due to fetal anemia. In these cases, with early surgical treatment provided, the incidence of severe complications and long-term consequences in children is very low, and parents should be informed during prenatal counseling. It is necessary to register all the SCT cases due to the rarity of this congenital anomaly for further statistical analysis of the importance of ultrasound markers.
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Affiliation(s)
- Anna Jouzova
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic.
- Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic.
| | - Martin Jouza
- Department of Neonatology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Jakub Turek
- Department of Pediatric Surgery, Orthopedics, and Traumatology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Romana Gerychova
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Marta Jezova
- Department of Pathology, University Hospital Brno, Brno, Czech Republic
| | - Petr Janku
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic
| | - Lukas Hruban
- Department of Obstetrics and Gynecology, University Hospital Brno, Brno, Czech Republic.
- Faculty of Medicine, Masaryk University Brno, Brno, Czech Republic.
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Abiad M, Zargarzadeh N, Javinani A, Krispin E, Shamshirsaz AA. Fetal Teratomas: Advances in Diagnosis and Management. J Clin Med 2024; 13:6245. [PMID: 39458194 PMCID: PMC11508798 DOI: 10.3390/jcm13206245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2024] [Revised: 10/14/2024] [Accepted: 10/17/2024] [Indexed: 10/28/2024] Open
Abstract
Fetal teratomas, though rare, represent a significant proportion of tumors arising during fetal development. These tumors arise from pluripotent cells and can present in varying degrees of severity, ranging from incidental findings to life-threatening conditions. Prenatal imaging, via ultrasound and MRI, is necessary for diagnosis and risk assessment. The management of fetal teratomas, particularly those associated with complications like hydrops or airway obstruction, often requires a multidisciplinary approach. Interventions such as ex-utero intrapartum treatment (EXIT) procedures and minimally invasive alternatives have emerged as critical tools to improve neonatal outcomes in severe cases. Despite advances in fetal therapies, careful prenatal monitoring and individualized management remain essential, especially for tumors with high vascularity or those that risk compromising cardiac output. This review explores the diagnostic methods, management strategies, and outcomes associated with fetal teratomas, highlighting recent advancements that contribute to improving survival and reducing morbidity in affected neonates.
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Affiliation(s)
| | | | | | | | - Alireza A. Shamshirsaz
- Fetal Care and Surgery Center (FCSC), Division of Fetal Medicine and Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
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Mandelbaum AD, Sun RC, Kim AJH, Sohaey R, Hakar M, Tavoosi S, Ward L, Rincon M, Allen AJ, Dukhovny S, Chon AH. Pregnancy and Long-Term Postnatal Outcomes of Congenital Sacrococcygeal Teratoma: A Single Institution's 18-Year Experience. Birth Defects Res 2024; 116:e2405. [PMID: 39425502 DOI: 10.1002/bdr2.2405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2024] [Revised: 07/30/2024] [Accepted: 09/12/2024] [Indexed: 10/21/2024]
Abstract
OBJECTIVE The objective of this study is to evaluate outcomes of fetal sacrococcygeal teratoma (SCT) from an academic tertiary center. STUDY DESIGN This is a retrospective study evaluating pregnancy and postnatal outcomes of fetal SCT management at a single institution between 2006 and 2023. Results are reported as median (range). RESULTS Fourteen patients with fetal SCT were studied. Hydrops fetalis occurred in 2 (14.3%) cases. Pregnancy course included expectant management in 12 (85.7%) and palliative preterm induction in 1 patient (7.1%). Indications for delivering timing included fetal deterioration in 7 patients (50%), preeclampsia in 3 (21.4%), elective induction of delivery in 3 (21.4%), and preterm labor in 1 (7.1%). Delivery GA was 36.4 weeks (26.4-40.1 weeks), with 11 (78.5%) cesareans and 3 (21.4%) vaginal deliveries. There were 13 (92.9%) live births and 11 (78.6%) long-term survivors. Postnatal resection pathology demonstrated 7 (53.8%) mature, 3 (23.1%) immature, and 3 (23.1%) malignant SCTs. Of the 11 long-term survivors, 3 (27.3%) had teratoma recurrences, including 2 (18.2%) with metastatic disease requiring chemotherapy. Notable long-term complications involved gastrointestinal (n = 7, 63.6%), genitourinary (n = 4, 36.4%), and musculoskeletal (n = 2, 18.2%) systems. CONCLUSION SCT confers significant morbidity to both the pregnant patient and neonate. Multidisciplinary prenatal and postnatal care is needed to comprehensively manage this complex condition.
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Affiliation(s)
- Ava D Mandelbaum
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Raphael C Sun
- Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Amanda J H Kim
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Roya Sohaey
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Melanie Hakar
- Department of Pathology and Laboratory Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Lucy Ward
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Monica Rincon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Allison J Allen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Stephanie Dukhovny
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Andrew H Chon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
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Creden SP, Portuondo J, Cheng LS, Halaweish I, Keswani SG, King AL, Lee TC, Sun RC. Approach and Technique for Cesarean Section to Immediate Resection for High-Risk Sacrococcygeal Teratomas. J Surg Res 2023; 292:38-43. [PMID: 37579714 DOI: 10.1016/j.jss.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/07/2023] [Accepted: 07/10/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Ex-utero intrapartum treatment has been established as an option for fetal and perinatal surgeons to deliver patients with sacrococcygeal teratomas (SCTs) which are causing significant fetal distress and possible in-utero fetal demise. However, ex-utero intrapartum treatment procedures carry significant maternal risk and morbidity. Herein, we report an alternative technique of Cesarean section to immediate resection (CSIR) for managing high-risk SCTs. METHODS A retrospective institutional review board-approved review was performed on all SCTs evaluated at our fetal center from May 2014 to September 2020. Demographics; prenatal imaging characteristics; prenatal interventions; and postnatal surgery data including operative time, estimated blood loss, pathology, and outcomes were collected. Outcomes of interest included surveillance serum alpha-fetoprotein levels, imaging surveillance, developmental milestones, and the presence or absence of constipation or fecal incontinence. RESULTS A total of 20 patients with prenatal diagnosis of SCT were evaluated. Mothers who transferred their care to another institution after diagnosis were excluded from this study. Twelve neonates underwent standard postnatal resection. Three neonates underwent emergent CSIR for high output cardiac failure, fetal anemia, or concerns for in-utero hemorrhagic rupture. The median (interquartile range) operative time was 231.5 (113) minutes for the standard operative group versus 156 min in the CSIR group. We present three patients who underwent immediate resection after emergent Cesarean section. We report 100% survival for the three consecutive cases. CONCLUSIONS CSIR is a safe and feasible approach for managing appropriately selected high-risk SCTs with signs of hydrops, fetal distress, or fetal anemia. Despite patient prematurity, we demonstrated 100% survival of three consecutive cases. We suggest that CSIR be considered an option in the management algorithm for high-risk SCTs.
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Affiliation(s)
- Samuel P Creden
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Jorge Portuondo
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Lily S Cheng
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Ihab Halaweish
- Division of Pediatric Surgery, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio
| | - Sundeep G Keswani
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Alice L King
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Timothy C Lee
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Raphael C Sun
- Division of Pediatric Surgery, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
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Li X, Lin HH, Hu KF, Peng Y. Prenatal MRI diagnosis and outcomes of abdominal or sacrococcygeal teratomas and parasitic fetuses. Front Pediatr 2023; 11:1181110. [PMID: 37744434 PMCID: PMC10516294 DOI: 10.3389/fped.2023.1181110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Objective To investigate the MRI findings of fetal abdominal or sacrococcygeal teratomas and parasitic fetuses and analyze the outcomes on the basis of follow-up assessments. Methods The MRI data of 60 cases of abdominal or sacrococcygeal masses were examined. The outcomes were followed up and compared with the prenatal MRI diagnoses. Results The 60 cases included 52 cases of sacrococcygeal teratomas and eight cases of abdominal lesions. The common types of sacrococcygeal teratomas were type I (21/52, 40.4%) and type II (20/52, 38.5%); type III sacrococcygeal teratomas were rarer (8/52, 15.4%), while type IV tumors (3/52, 5.7%) were frequently complicated with hydronephrosis. Other complications included polyhydramnios in 22 cases, placental edema in six cases, and fetal hydronephrosis in three cases (all type IV). Seven of the eight parasitic fetuses were located in the abdominal cavity, and one was located in the sacrococcygeal region. Postnatal surgery was performed in 51 cases (51/60), including 44 with teratomas and seven with parasitic fetuses. In one case with hydronephrosis, peritoneal effusion, and subcutaneous edema, treatment was discontinued after birth (1/60). Fetal induction of labor was observed in eight cases (8/60). Prenatal ultrasound yielded incorrect or ambiguous diagnoses in 11 cases, while 51 cases showed a favorable course after surgery. Conclusions MRI shows high accuracy in the diagnosis of fetal sacrococcygeal teratomas and parasitic fetuses. The prognosis in these cases is generally good. However, type IV sacrococcygeal teratomas are prone to fetal hydronephrosis and misdiagnosis and show a poorer prognosis.
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Affiliation(s)
- Xu Li
- Department of Radiology, Anhui Provincial Children’s Hospital, Hefei, China
| | - Hui hui Lin
- Department of Radiology, Anhui Provincial Children’s Hospital, Hefei, China
| | - Ke fei Hu
- Department of Radiology, Anhui Provincial Children’s Hospital, Hefei, China
| | - Yun Peng
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Pace E, Johnson TS, Kao SC, Parikh AK, Qi J, Rajderkar DA, Reid JR, Towbin AJ, States LJ. Imaging of pediatric extragonadal pelvic soft tissue tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29966. [PMID: 36482882 PMCID: PMC10710207 DOI: 10.1002/pbc.29966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/16/2022] [Indexed: 12/13/2022]
Abstract
The most common pediatric extragonadal pelvic cancers include germ cell tumors, sacrococcygeal teratomas, and rhabdomyosarcomas (arising from the urinary bladder, prostate, paratesticular tissues, vagina, uterus, and perineum). This paper describes the radiological and nuclear medicine features of these entities and provides consensus-based recommendations for the assessment at diagnosis, during, and after treatment.
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Affiliation(s)
- Erika Pace
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, England, United Kingdom
| | - Tatum S. Johnson
- Department of Radiology, Brenner Children’s Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Simon C. Kao
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ashish K. Parikh
- Department of Radiology, Emory University Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jing Qi
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dhanashree A. Rajderkar
- Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Janet R. Reid
- Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexander J. Towbin
- Department of Radiology, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | - Lisa J. States
- Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Moradi B, Banihashemian M, Radmard AR, Tahmasebpour AR, Gity M, Dadali A, Piri S, Zeinoddini A, Najafi E. A Spectrum of Ultrasound and MR Imaging of Fetal Gastrointestinal Abnormalities: Part 2 Anorectal Malformation, Liver, and Abdominal Wall Anomalies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2615-2627. [PMID: 34962310 DOI: 10.1002/jum.15929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 06/14/2023]
Abstract
Ultrasound (US) and magnetic resonance imaging (MRI) are two modalities for diagnosing fetal gastrointestinal (GI) anomalies. Ultrasound (US) is the modality of choice. MRI can be used as a complementary method. Despite its expanding utilization in central nervous system (CNS) fetal malformation, MRI has not yet been established for evaluation of fetal GI abnormalities. Therefore, more attention should be paid to the clinical implications of MRI investigations following screening by US.
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Affiliation(s)
- Behnaz Moradi
- Department of Radiology, Yas Complex Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Banihashemian
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Masoumeh Gity
- Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Medical Imaging Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Dadali
- MBBS Student, St George's University of London, London, United Kingdom
| | - Solmaz Piri
- Department of International Affairs, National Association of Iranian Gynecologists and Obstetricians, Tehran, Iran
| | - Atefeh Zeinoddini
- Department of Radiology, University of Texas Medical Branch, Galveston, TX, USA
| | - Ehsan Najafi
- Department of Orthopedic and Trauma Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Imaging of Congenital Spine Malformations. Clin Perinatol 2022; 49:623-640. [PMID: 36113926 DOI: 10.1016/j.clp.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Congenital malformations of the spine and spinal cord are a large and diverse group of diagnoses, which are often broadly referred to as spinal dysraphisms (SDs). Derived from the Greek words dys (bad) and raphe (suture), the term dysraphism describes missteps in the process of forming a midline seam during the zipper-like fusion of the neural folds in primary neurulation. As such, the term "spinal dysraphism" is a designation that should technically be reserved for malformations resulting from aberrations in primary neurulation. In medical practice, however, it is a catch-all designation regularly used to describe any of the numerous abnormalities demonstrating incomplete midline closure of mesenchymal, osseous, and nervous tissue, occurring at any point during embryologic development. For the sake of clarity and completeness, this article will also include that breadth in the discussion of congenital abnormalities of the spine.
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Fattahi N, Moeini A, Morani AC, Elsayes KM, Bhosale HR, Badawy M, Menias CO, Rezvani M, Gaballah AH, Shaaban AM. Fat-containing pelvic lesions in females. Abdom Radiol (NY) 2022; 47:362-377. [PMID: 34673996 DOI: 10.1007/s00261-021-03299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Abstract
Pelvic tumors are common in females and have a broad differential diagnosis. The clinical management of pelvic tumors varies widely-from observation to surgical resection-and imaging plays a pivotal role in diagnosis and clinical decision-making in these cases. In particular, imaging can help determine the organ of origin and tissue content of these tumors, which are the most important steps to narrowing the differential diagnosis. Fat has a characteristic appearance and is often easily identified on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). The amount and distribution of intralesional fat varies in different types of tumors. Macroscopic intralesional fat is often easily recognized by its hyperechoic appearance on US and low attenuation on CT similar to subcutaneous fat. On MRI, macroscopic fat is hyperintense on T1-weighted (T1W) images, with characteristic signal loss on fat-saturated sequences and India-ink artifact on opposed-phase T1W images. Macroscopic fat is the hallmark of teratomas, which are the most common ovarian neoplasms. Uterine lipoleiomyomas, peritoneal loose bodies, intraperitoneal and extraperitoneal primary lipomatous tumors such as lipoma and liposarcomas, and extra-adrenal myelolipomas are other pelvic masses distinguished by the presence of macroscopic fat. However, the imaging diagnosis of pelvic masses containing minimal or microscopic fat, such as immature ovarian teratomas, steroid cell ovarian neoplasms, and extramedullary hematopoiesis, can present a diagnostic challenge owing to their nonspecific appearance on US or CT. Obtaining MRI with in-phase and opposed-phase dual-echo T1W sequences and depicting chemical shift artifacts can be helpful in distinguishing these lesions.
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Affiliation(s)
- Nikoo Fattahi
- Department of Diagnostic and Interventional Imaging, The University of Texas John P. and Katherine G. McGovern Medical School, Houston, TX, USA
| | - Aida Moeini
- Department of Diagnostic Imaging, The University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Ajaykumar C Morani
- Division of Diagnostic Imaging, Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | - Khaled M Elsayes
- Division of Diagnostic Imaging, Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA.
| | | | - Mohamed Badawy
- Division of Diagnostic Imaging, Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA
| | | | - Maryam Rezvani
- Department of Diagnositc Imaging, The University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ayman H Gaballah
- Department of Radiology, The University of Missouri Health Care, Columbia, MO, USA
| | - Akram M Shaaban
- Department of Diagnositc Imaging, The University of Utah School of Medicine, Salt Lake City, UT, USA
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Masselli G, Cozzi D, Ceccanti S, Laghi F, Giancotti A, Brunelli R. Fetal body MRI for fetal and perinatal management. Clin Radiol 2021; 76:708.e1-708.e8. [PMID: 34112509 DOI: 10.1016/j.crad.2021.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 05/05/2021] [Indexed: 12/19/2022]
Abstract
Fetal magnetic resonance imaging (MRI) has become a valuable adjunct to ultrasound (US) in diagnosing fetal abnormalities. This review is intended to highlight the contribution of MRI in parental counselling and perinatal treatment. A state-of-the-art fetal MRI protocol with experts of maternal-fetal medicine present in the MRI suite allows emphasis on patient-centred care and maximises therapeutic options.
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Affiliation(s)
- G Masselli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy.
| | - D Cozzi
- Pediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| | - S Ceccanti
- Pediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| | - F Laghi
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - A Giancotti
- Department of Gynecological, Obstetrical, and Urological Sciences, Sapienza University, Rome, Italy
| | - R Brunelli
- Department of Gynecological, Obstetrical, and Urological Sciences, Sapienza University, Rome, Italy
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Davidson JR, Uus A, Matthew J, Egloff AM, Deprez M, Yardley I, De Coppi P, David A, Carmichael J, Rutherford MA. Fetal body MRI and its application to fetal and neonatal treatment: an illustrative review. THE LANCET. CHILD & ADOLESCENT HEALTH 2021; 5:447-458. [PMID: 33721554 PMCID: PMC7614154 DOI: 10.1016/s2352-4642(20)30313-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/28/2020] [Accepted: 09/08/2020] [Indexed: 12/14/2022]
Abstract
This Review depicts the evolving role of MRI in the diagnosis and prognostication of anomalies of the fetal body, here including head and neck, thorax, abdomen and spine. A review of the current literature on the latest developments in antenatal imaging for diagnosis and prognostication of congenital anomalies is coupled with illustrative cases in true radiological planes with viewable three-dimensional video models that show the potential of post-acquisition reconstruction protocols. We discuss the benefits and limitations of fetal MRI, from anomaly detection, to classification and prognostication, and defines the role of imaging in the decision to proceed to fetal intervention, across the breadth of included conditions. We also consider the current capabilities of ultrasound and explore how MRI and ultrasound can complement each other in the future of fetal imaging.
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Affiliation(s)
- Joseph R Davidson
- Prenatal Cell and Gene Therapy, Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK; UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Alena Uus
- Stem Cells and Regenerative Medicine; Perinatal Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Jacqueline Matthew
- Stem Cells and Regenerative Medicine; Perinatal Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Alexia M Egloff
- Stem Cells and Regenerative Medicine; Perinatal Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Maria Deprez
- Stem Cells and Regenerative Medicine; Perinatal Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Iain Yardley
- Paediatric Surgery, Evelina London Children's Hospital, London, UK
| | - Paolo De Coppi
- UCL Great Ormond Street Institute of Child Health, University College London, London, UK; Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, UK; Katholieke Universiteit Leuven, Leuven, Belgium
| | - Anna David
- Prenatal Cell and Gene Therapy, Elizabeth Garrett Anderson Institute of Women's Health, University College London, London, UK; Fetal Medicine Unit, University College London, London, UK
| | - Jim Carmichael
- Paediatric Radiology, Evelina London Children's Hospital, London, UK
| | - Mary A Rutherford
- Stem Cells and Regenerative Medicine; Perinatal Imaging, School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
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Muthee BW, Bray HJ. Approach to the postnatal sonographic evaluation of prenatally detected abdominopelvic cysts. Ultrasonography 2021; 41:53-73. [PMID: 34344138 PMCID: PMC8696132 DOI: 10.14366/usg.21070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/22/2021] [Indexed: 11/10/2022] Open
Abstract
Prenatally detected abdominal and pelvic masses are commonly cystic in morphology and usually seen on mid-trimester sonography. Sonography is the favored imaging modality for the postnatal evaluation of these lesions in newborns, given its availability, low cost, lack of ionizing radiation, lack of sedation, and high spatial resolution in small patients. The differential diagnosis of abdominopelvic cystic masses in newborns is broad given that they can arise from many organs and may have overlapping features on imaging. This article illustrates an approach to the postnatal sonographic evaluation of prenatally detected cystic abdominal and pelvic masses based on their anatomic location and distinctive sonographic characteristics, which can aid in an accurate diagnosis and guide appropriate management.
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Affiliation(s)
- Bernadette Wambui Muthee
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Heather J Bray
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, BC, Canada
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13
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Özsürmeli M, Büyükkurt S, Sucu M, Arslan E, Mısırlıoğlu S, Akçabay Ç, Kayapınar M, Demir SC, Evrüke İC. Evaluation of prenatally diagnosed fetal sacrococcygeal teratomas: A case series of seventeen pregnancies from South-central Turkey. Turk J Obstet Gynecol 2020; 17:170-174. [PMID: 33072420 PMCID: PMC7538821 DOI: 10.4274/tjod.galenos.2020.68812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/19/2020] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate sacrococcygeal teratoma (SCT) cases according to associated cardiac, extracardiac, and chromosomal anomalies in the prenatal period, and to review their outcomes. Materials and Methods Data of pregnancies with a prenatal diagnosis of SCT between 2009 and 2019 were retrospectively reviewed. Results One ongoing pregnancy was excluded. There were five medically terminated cases, three due to severe heart failure and the remaining two due to additional congenital defects. Two infants who had heart failure due to hyperdynamic flow died in the neonatal period. Nine infants are well and alive at the time of writing. Conclusion When a lesion is detected in the sacrococcygeal region during fetal sonography, the differential diagnosis should be made with an appropriate evaluation with emphasis on a possible diagnosis of fetal SCT. Tumor growth and heart failure should be monitored with serial scans when SCT has been diagnosed prenatally.
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Affiliation(s)
- Mehmet Özsürmeli
- University of Health Sciences Turkey, Kocaeli Derince Training and Research Hospital, Clinic of Obstetrics and Gynecology, Kocaeli, Turkey
| | - Selim Büyükkurt
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Mete Sucu
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Erol Arslan
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Selahattin Mısırlıoğlu
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Çiğdem Akçabay
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Masum Kayapınar
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - Süleyman Cansun Demir
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
| | - İsmail Cüneyt Evrüke
- Çukurova University Faculty of Medicine, Department of Obstetrics and Gynecology, Perinatology Unit, Adana, Turkey
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14
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Sacrococcygeal teratoma with intraspinal extension: A case series and review of literature. J Pediatr Surg 2020; 55:2022-2025. [PMID: 32115228 DOI: 10.1016/j.jpedsurg.2020.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/03/2019] [Accepted: 02/05/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sacrococcygeal teratoma (SCT) is the most common teratoma in neonates and arises from the coccyx. SCT with intraspinal invasion is extremely rare and only reported in a few cases. METHODS 37 patients with SCT were identified at our institution between 2000 and 2018. Three of these patients had SCT with intraspinal extension. A literature review for intraspinal extension associated with SCT, including mode of diagnosis, presentation, surgical approach and neurological sequelae, between 1993 and 2018 was also conducted. RESULTS The authors report three cases of infants who were antenatally and/or postnatally diagnosed with a sacrococcygeal teratoma extending into the spinal canal. We illustrate the challenges of accurate diagnosis and therapeutic management. Postnatal magnet resonance imaging (MRI) was the best method to define spinal anatomy and extension of the tumors prior to surgery. Management with a multidisciplinary team approach including neuroradiology, neurosurgery and general surgery was used in our two most recent patients. The literature review yielded 6 cases of SCT with intraspinal extension. CONCLUSION Intraspinal extension in SCT is rare but should be excluded at birth before attempting any resection. In case of positive spinal invasion on Ultrasonography (US), MRI is essential to plan for surgery and possible laminectomy to be able to perform a radical resection of this congenital tumor. We recommend this multidisciplinary approach. LEVEL OF EVIDENCE Level IV.
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15
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Sacrococcygeal teratoma with intraspinal extension. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2019.101340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Unveiling the tale of the tail: an illustration of spinal dysraphisms. Neurosurg Rev 2019; 44:97-114. [PMID: 31811517 DOI: 10.1007/s10143-019-01215-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/31/2019] [Accepted: 11/20/2019] [Indexed: 01/15/2023]
Abstract
Spinal dysraphism is an umbrella term describing herniation of meninges or neural elements through defective neural arch. They can be broadly categorized into open and closed types. MRI is the investigation of choice to study neural abnormalities and to assess the severity of hydrocephalus and Chiari malformation. Knowledge of the embryology of these disorders is valuable in correctly identifying the type of dysraphism. The aim of surgery is untethering and dural reconstruction. Accurate depiction of the abnormal anatomy in cases of spinal dysraphism is of utmost importance for surgical management of these patients. MRI makes this possible due to its excellent soft tissue contrast resolution and multiplanar capability, allowing the radiologist to evaluate the intricate details in small pediatric spinal structures. Imaging enlightens the surgeons about the status of spinal cord and other associated abnormalities and helps detect re-tethering in operated cases. Besides, antenatal surgery to repair myelomeningoceles has made detection of open dysraphisms on fetal MRI and antenatal ultrasound critical. The purpose of this review is to describe the development of spine, illustrate the myriad imaging features of open and closed spinal dysraphisms, and enlist the reporting points the operating surgeon seeks from the radiologist.
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17
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Jumbi T, Shahbal S, Osawa F, Kambuni F, Mwika P. Sacrococcygeal teratoma type IV presenting with urine retention in infants. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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18
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Matos APP, Duarte LDB, Castro PT, Daltro P, Werner Júnior H, Araujo Júnior E. Evaluation of the fetal abdomen by magnetic resonance imaging. Part 2: abdominal wall defects and tumors. Radiol Bras 2018; 51:187-192. [PMID: 29991841 PMCID: PMC6034725 DOI: 10.1590/0100-3984.2016.0142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Although ultrasound is still the gold standard for the assessment of fetal malformations, magnetic resonance imaging (MRI) has gained great prominence in recent years. In situations in which ultrasound has low sensitivity, such as maternal obesity, abdominal scarring, and oligohydramnios, MRI has proven to be a safe and accurate method. Regarding fetal abdominal wall defects, MRI appears to be widely used in the prognostic assessment of gastroschisis with intestinal atresia or of complications of omphalocele, allowing better perinatal management and parental counseling. In addition, MRI allows the assessment of local invasion of fetal abdominal tumors, with significant prognostic value for the postnatal period. In this article, we review the main MRI findings in the evaluation of fetal abdominal wall defects and tumors.
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Affiliation(s)
- Ana Paula Pinho Matos
- MD, Physician in the Radiology Department of the Clínica de Diagnóstico Por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Luciana de Barros Duarte
- PhD, Adjunct Professor in the Department of Maternal-Infant Care of the Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
| | - Pedro Teixeira Castro
- MSc, MD, Physician in the Radiology Department of the Clínica de Diagnóstico Por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Pedro Daltro
- PhD, MD, Physician in the Radiology Department of the Clínica de Diagnóstico Por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Heron Werner Júnior
- PhD, MD, Physician in the Radiology Department of the Clínica de Diagnóstico Por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Edward Araujo Júnior
- Tenured Adjunct Professor in the Department of Obstetrics of the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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19
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Value of Fetal MRI in the Era of Fetal Therapy for Management of Abnormalities Involving the Chest, Abdomen, or Pelvis. AJR Am J Roentgenol 2018. [DOI: 10.2214/ajr.17.18948] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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20
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Platt LD, Barth RA, Pugash D. Current controversies in prenatal diagnosis 3: Fetal MRI should be performed in all prenatally detected fetuses with a major structural abnormality. Prenat Diagn 2018; 38:166-172. [DOI: 10.1002/pd.5219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/07/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Lawrence D. Platt
- Obstetrics and Gynecology, David Geffen School of Medicine at UCLA; Center for Fetal Medicine and Women's Ultrasound; Los Angeles CA USA
| | - Richard A. Barth
- Stanford University School of Medicine; Lucile Packard Children's Hospital at Stanford; Stanford CA USA
| | - Denise Pugash
- 1T48 Ultrasound, BC Women's Hospital; University of British Columbia; Vancouver British Columbia Canada
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21
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Yoon HM, Byeon SJ, Hwang JY, Kim JR, Jung AY, Lee JS, Yoon HK, Cho YA. Sacrococcygeal teratomas in newborns: a comprehensive review for the radiologists. Acta Radiol 2018; 59:236-246. [PMID: 28530139 DOI: 10.1177/0284185117710680] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Sacrococcygeal teratomas are the most common solid tumor in newborn infants. The diagnosis is not difficult in many cases; however, there should be additional information on imaging studies in order to manage those infants properly. Details include histology, morphologic classification, complications such as rupture, bleeding, and mass effects on the adjacent structures. Although imaging features cannot accurately predict the histologic subtypes of the tumors, thorough evaluation of the imaging features can help distinguish malignant tumors from benign tumors. In this article, pathogenesis, histological characteristics, clinical considerations, and morphologic characteristics will be discussed.
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Affiliation(s)
- Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Sun-ju Byeon
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jae-Yeon Hwang
- Department of Radiology, Pusan National University Children's Hospital, Yangsan-Si, Republic of Korea
| | - Jeong Rye Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Hye-Kyung Yoon
- Department of Radiology, Kangwon National University Hospital, Chuncheon-Si, Republic of Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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22
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Radiological features of sacrococcygeal teratomas in fetal magnetic resonance imaging and computed tomography - a case report. Pol J Radiol 2018; 83:e19-e23. [PMID: 30038674 PMCID: PMC6047081 DOI: 10.5114/pjr.2018.74861] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/11/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose Sacrococcygeal teratomas (SCT) can be detected in ultrasonography as early as in the first trimester. Currently, prenatal ultrasonography enables a thorough examination of tumors, but it is not always sufficient. The purpose of this study was to determine the most important features of SCTs in fetal magnetic resonance imaging and to confront them with postnatal computed tomography (CT). Case report Between 2009 and 2013, 5 cases of sacrococcygeal teratomas were diagnosed in our hospital using fetal magnetic resonance imaging (3 female and 2 male infants). Three of the affected newborns underwent postnatal CT before surgery. In each case, tumor size, its content, mass effect, and classification according to the Altman’s criteria were determined and compared with other features. Fetal magnetic resonance imaging (MRI) and postnatal CT were in excellent agreement with respect to tumor classification using the aformentioned criteria. MRI better characterizes tumor content and its extent compared to ultrasound, and enables a precise structural assessment of the central nervous system. Postnatal CT is complementary to fetal MRI and optional. Conclusions Fetal MRI may help in the prenatal diagnosis of SCTs as it overcomes the limitations of obstetric ultrasound. Postnatal computed tomography is useful in determining tumor vascularity or calcifications, and it can depict the surrounding bone structures.
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23
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Surgical treatment of a type IV cystic sacrococcygeal teratoma with intraspinal extension utilizing a posterior-anterior-posterior approach: a case report. Childs Nerv Syst 2018; 34:977-982. [PMID: 29368306 PMCID: PMC5895678 DOI: 10.1007/s00381-018-3718-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/02/2018] [Indexed: 02/01/2023]
Abstract
Type IV sacrococcygeal teratoma with intraspinal involvement is rare and to our knowledge has not been reported previously in the literature. The authors present the case of a 2-month-old infant with a type IV sacrococcygeal teratoma diagnosed on prenatal ultrasound. Postnatal MRI revealed intraspinal extension through an enlarged sacral neuroforamina on the right side. On surgical exploration, the authors discovered a dorsal cystic tumor involving the sacral spine that extended through an enlarged S4 foramen to a large presacral component. The tumor was successfully removed to achieve a complete en bloc surgical resection. The authors review the epidemiology, pathophysiology, and treatment of sacrococcygeal teratomas with intraspinal extension.
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24
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Abstract
Fetal MRI is a level III diagnostic tool performed subsequently a level II prenatal ultrasound (US), in cases of inconclusive ultrasonographic diagnosis or when a further investigation is required to confirm or improve the diagnosis, to plan an appropriate pregnancy management. Fetal MRI plays an increasingly important role in the prenatal diagnosis of fetal neck, chest and abdominal malformations, even if its role has been amply demonstrated, especially, in the field of fetal CNS anomalies. Due to its multiparametricity and multiplanarity, MRI provides a detailed evaluation of the whole fetal respiratory, gastrointestinal and genitourinary systems, especially on T2-weighted (W) images, with a good tissue contrast resolution. In the evaluation of the digestive tract, T1-W sequences are very important in relation to the typical hyperintensity of the large intestine, due to the presence of meconium. The objective of this review is to focus on the application of fetal MRI in neck, chest and abdominal diseases.
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25
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Abstract
Recent improvements in fetal therapies and perinatal care and the multidisciplinary involvement in fetal medicine have increased the demand for more accurate prenatal diagnosis. Fetal Magnetic Resonance Imaging (MRI) is a complementary imaging technique for the assessment of thoraco-abdominal anomalies for which Ultrasonography (US) is not conclusive. It is indicated in selected situations to precise the prognosis in diaphragmatic hernia, to characterise the nature and extension of a pulmonary malformation, to locate a bowel atresia or to better depict an abdominal cystic lesion or tumoural extension. It has become a mandatory complementary diagnostic tool and improves the management of the fetuses and newborns.
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26
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Kumar J, Afsal M, Garg A. Imaging spectrum of spinal dysraphism on magnetic resonance: A pictorial review. World J Radiol 2017; 9:178-190. [PMID: 28529681 PMCID: PMC5415887 DOI: 10.4329/wjr.v9.i4.178] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 02/15/2017] [Accepted: 03/02/2017] [Indexed: 02/06/2023] Open
Abstract
Congenital malformations of spine and spinal cord are collectively termed as spinal dysraphism. It includes a heterogeneous group of anomalies which result from faulty closure of midline structures during development. Magnetic resonance imaging (MRI) is now considered the imaging modality of choice for diagnosing these conditions. The purpose of this article is to review the normal development of spinal cord and spine and reviewing the MRI features of spinal dysraphism. Although imaging of spinal dysraphism is complicated, a systematic approach and correlation between neuro-radiological, clinical and developmental data helps in making the correct diagnosis.
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Archontaki S, Vial Y, Hanquinet S, Meuli R, Alamo L. Magnetic resonance imaging of fetal pelvic cysts. Abdom Radiol (NY) 2016; 41:2445-2454. [PMID: 27909773 DOI: 10.1007/s00261-016-0980-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The detection of fetal anomalies has improved in the last years as a result of the generalization of ultrasound pregnancy screening exams. The presence of a cystic imaging in the fetal pelvis is a relatively common finding, which can correspond to a real congenital cystic lesion or result from the anomalous liquid accumulation in a whole pelvic organ, mainly the urinary bladder, the uterus, or the vagina. In selected cases with poor prognosis and/or inconclusive echographic findings, magnetic resonance may bring additional information in terms of the characterization, anatomical location, and real extension of the pathology. This pictorial essay describes the normal pelvic fetal anatomy, as well as the most common pelvic cysts. It also describes the causes of an anomalous distension of the whole pelvic organs detected in utero, with emphasis on prenatal magnetic resonance imaging exams. Moreover, it proposes practical teaching points to reduce the differential diagnosis of these lesions based on the sex of the fetus, the division of the pelvis in anatomical spaces, and the imaging findings of the pathology. Finally, it discusses the real utility of complementary MRI.
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Affiliation(s)
- Styliani Archontaki
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV), Rue du Bugnon, 46, Lausanne, 1011, Switzerland
- Department of Radiology, Hospital of Yverdon, Rue d'Entremonts 11, Yverdon-les-Bains, 1400, Switzerland
| | - Yvan Vial
- Department of Gynecology and Obstetrics, University Hospital of Lausanne (CHUV), Rue du Bugnon, 46, Lausanne, 1011, Switzerland
| | - Sylviane Hanquinet
- Department of Pediatric Radiology, University Hospital of Geneve (HUG), Rue Willy-Donzé 6, Geneva, 1205, Switzerland
| | - Reto Meuli
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV), Rue du Bugnon, 46, Lausanne, 1011, Switzerland
| | - Leonor Alamo
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne (CHUV), Rue du Bugnon, 46, Lausanne, 1011, Switzerland.
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28
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Dedushi K, Kabashi S, Mucaj S, Ramadani N, Hoxhaj A, Shatri J, Hasbahta G. Magnetic Resonance Imaging Verification of a Case of Sacrococcygeal Teratoma. World J Oncol 2016; 7:81-84. [PMID: 28983369 PMCID: PMC5624704 DOI: 10.14740/wjon965w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2016] [Indexed: 11/11/2022] Open
Abstract
Although rare, sacrococcygeal teratoma is the most common congenital neoplasm, occurring in 1 in 40,000 infants. Approximately 75% of affected infants are female. The aim of the present study was to correlate ultrasonography and magnetic resonance imaging (MRI) findings in patients with fetal sacrococcygeal teratoma. Three pregnant women in 27th week of gestation underwent fetal MRI after ultrasonography examination, with findings suggestive for fetal sacrococcygeal teratoma. Tumor size, location, extent and content were evaluated both by MRI and ultrasonography. Findings regarding tumor location, size and content were similar for both methods. There was a large well-circumscribed mixed, cystic/solid oval mass, originating from right sacro-gluteal region and projecting into the amniotic cavity, 132 × 110 × 76 mm in size. The mass had a heterogeneous appearance. The T1 high signal suggested fat component of the tumor, while T1 and T2 hypointense components suggested calcified/bony components. There was also T1 hypointense component consistent with cystic and fluid component. The imaging findings were characteristic for sacrococcygeal teratoma. There was not obvious lumbar or thoracic spinal involvement. There was no gross intrapelvic or abdominal extension, and even sacrum and coccyx appeared deformed. The amount of amniotic fluid was increased. MRI was superior to ultrasonography in the evaluation of the exact tumor extent, accurately demonstrating pelvic involvement in all of the three cases. Fetal MRI has shown to be a valuable adjunct to obstetric sonography in the evaluation of fetal sacrococcygeal teratoma, because of its higher accuracy in the determination of tumors extent and content, playing a significant role in the therapeutic planning and increasing the chances of cure for these fetuses.
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Affiliation(s)
- Kreshnike Dedushi
- Faculty of Medicine, Pristine University, Pristine City, 10000, Kosovo.,Department of Radiology, Diagnostic Centre, UCCK, Pristine City, 10000, Kosovo.,Diagnostic Center, International Health Center "IHC", Pristine City, 10000, Kosovo
| | - Serbeze Kabashi
- Faculty of Medicine, Pristine University, Pristine City, 10000, Kosovo.,Department of Radiology, Diagnostic Centre, UCCK, Pristine City, 10000, Kosovo
| | - Sefedin Mucaj
- Faculty of Medicine, Pristine University, Pristine City, 10000, Kosovo.,National Institute of Public Health of Kosovo, Pristine City, 10000, Kosovo
| | - Naser Ramadani
- Faculty of Medicine, Pristine University, Pristine City, 10000, Kosovo.,National Institute of Public Health of Kosovo, Pristine City, 10000, Kosovo
| | | | - Jeton Shatri
- Faculty of Medicine, Pristine University, Pristine City, 10000, Kosovo.,Department of Radiology, Diagnostic Centre, UCCK, Pristine City, 10000, Kosovo
| | - Gazmend Hasbahta
- Department of Radiology, Diagnostic Centre, UCCK, Pristine City, 10000, Kosovo
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29
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Dogan S, Dogan MS, Doganay S, Koc G, Gorkem SB, Coskun A. Immature Cystic Teratoma Filling the Spinal Column. JOURNAL OF FETAL MEDICINE 2016. [DOI: 10.1007/s40556-016-0075-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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30
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Russell A. Investigation of a fetal mass - sacrococcygeal teratoma. SONOGRAPHY 2015. [DOI: 10.1002/sono.12041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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31
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Akinkuotu AC, Coleman A, Shue E, Sheikh F, Hirose S, Lim FY, Olutoye OO. Predictors of poor prognosis in prenatally diagnosed sacrococcygeal teratoma: A multiinstitutional review. J Pediatr Surg 2015; 50:771-4. [PMID: 25783370 DOI: 10.1016/j.jpedsurg.2015.02.034] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 02/13/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Attempts at defining predictors of poor outcome in fetal sacrococcygeal teratoma (SCT) have been hampered by small patient numbers. We sought to validate the utility of tumor volume to fetal weight ratio (TFR) as a predictor of poor prognosis and to identify other morphological outcome predictors in a multicenter series. METHODS Records of prenatally diagnosed SCT at three fetal centers from 1986 to 2011 were reviewed. Prenatal imaging characteristics including TFR, morphology, hydrops, and placentomegaly were assessed. Poor prognosis was defined as fetal demise, need for fetal intervention, or perinatal death. Receiver operating characteristic (ROC) analysis was used to select a TFR cutoff value. RESULTS Seventy-nine fetuses with SCT were evaluated. Eleven pregnancies ending in elective termination were excluded. ROC analysis revealed that TFR >0.12 prior to 24 weeks gestation was predictive of poor prognosis (AUC=0.913; Sensitivity=91.7%, Specificity=76.2%, PPV=86.8%; NPV=84.2%). Solid tumor morphology and presence of hydrops were found to be predictors of poor prognosis. None of the factors associated with poor prognosis were independent predictors on multivariate analysis. CONCLUSION This study validates TFR >0.12 prior to 24 weeks gestation as an objective predictor of outcomes in fetuses with SCT that can be easily applied in most clinical settings.
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Affiliation(s)
- Adesola C Akinkuotu
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Alan Coleman
- Department of Pediatric Surgery, Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eveline Shue
- Department of Surgery, Division of Pediatric Surgery and Fetal Treatment Center, University of California, San Francisco, San Francisco, CA, USA
| | - Fariha Sheikh
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Shinjiro Hirose
- Department of Surgery, Division of Pediatric Surgery and Fetal Treatment Center, University of California, San Francisco, San Francisco, CA, USA
| | - Foong-Yen Lim
- Department of Pediatric Surgery, Fetal Care Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Oluyinka O Olutoye
- Texas Children's Fetal Center, Baylor College of Medicine, Houston, TX, USA; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA; Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
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Adekola H, Mody S, Bronshtein E, Puder K, Abramowicz JS. The clinical relevance of fetal MRI in the diagnosis of Type IV cystic sacrococcygeal teratoma--a review. Fetal Pediatr Pathol 2015; 34:31-43. [PMID: 25183379 DOI: 10.3109/15513815.2014.949934] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The introduction of fetal magnetic resonance imaging (MRI) has improved the prenatal evaluation of uterine, placental and fetal anatomy. However, its utilization has mostly been restricted to fetal central nervous system anomalies. We review how adjunct fetal MRI was performed and diagnosis of cystic type IV sacrococcygeal teratoma was made. We also discuss the clinical relevance of fetal MRI in differentiating this lesion from other selected abdominal/pelvic cystic malformations and lesions.
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Affiliation(s)
- Henry Adekola
- 1Department of Obstetrics and Gynecology, Hutzel Women Hospital, Wayne State University School of Medicine, Detroit Michigan
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33
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Plunk MR, Chapman T. The fundamentals of fetal magnetic resonance imaging: Part 2. Curr Probl Diagn Radiol 2014; 43:347-55. [PMID: 24974309 DOI: 10.1067/j.cpradiol.2014.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 05/22/2014] [Indexed: 11/22/2022]
Abstract
Careful assessment of fetal anatomy by a combination of ultrasound and fetal magnetic resonance imaging offers the clinical teams and counselors caring for the patient information that can be critical for the management of both the mother and the fetus. In the second half of this 2-part review, we focus on space-occupying lesions in the fetal body. Because developing fetal tissues are programmed to grow rapidly, mass lesions can have a substantial effect on the formation of normal adjacent organs. Congenital diaphragmatic hernia and lung masses, fetal teratoma, and intra-abdominal masses are discussed, with an emphasis on differential etiologies and on fundamental management considerations.
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Affiliation(s)
- Matthew R Plunk
- Department of Radiology, University of Washington School of Medicine, Seattle, WA
| | - Teresa Chapman
- Department of Radiology, University of Washington School of Medicine, Seattle, WA; Department of Radiology, Seattle Children׳s Hospital, Seattle, WA.
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Abstract
Both benign and malignant pelvic masses are encountered in the pediatric population. Although ultrasonography remains the modality of choice for initial evaluation of a pediatric pelvic mass, in selected cases magnetic resonance (MR) imaging can add important diagnostic information. MR imaging has several advantages over ultrasonography and computed tomography, including superior contrast resolution and an ability to characterize abnormalities based on unique tissue characteristics. MR evaluation assists in lesion characterization, presurgical planning, and staging when a malignancy is suspected. MR imaging also offers a nonionizing imaging modality for long-term follow-up of patients undergoing therapy for malignant pelvic masses.
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Affiliation(s)
- Deepa R Pai
- Section of Pediatric Radiology, Department of Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, 1540 E. Hospital Drive, Ann Arbor, MI 48109-4252, USA
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Coleman A, Shaaban A, Keswani S, Lim FY. Sacrococcygeal teratoma growth rate predicts adverse outcomes. J Pediatr Surg 2014; 49:985-9. [PMID: 24888848 DOI: 10.1016/j.jpedsurg.2014.01.036] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 01/27/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to characterize the growth rate of sacrococcygeal teratomas (SCTs) and determine its relationship to adverse outcomes. METHODS A retrospective review of all pathology-confirmed isolated SCT patients evaluated with at least two documented ultrasounds and followed through hospital discharge between 2005 and 2012 was conducted. SCT growth rate was calculated as the difference between tumor volumes on a late- and early-gestation ultrasound divided by the difference in time. Outcomes were death, high-output cardiac failure (HOCF), hydrops, and preterm delivery. Student's t-test, receiver operator characteristics, Fisher's Exact test, and Pearson's correlation were performed. RESULTS Of the 28 study subjects, there were 3 in utero demises and 2 neonatal deaths. Significantly faster SCT growth rates were seen in all adverse outcomes, including death (p<0.0001), HOCF (p=0.005), and preterm delivery (p=0.009). There was a significant association with adverse outcomes at >61cm(3)/week (AUC=0.87, p=0.001, LR=4.52). Furthermore, there was an even greater association with death at >165cm(3)/week (AUC=0.93, p=0.003, LR=18.42). Growth rate was directly correlated with the percent of solid tumor (r=0.60, p=0.0008). CONCLUSION Faster SCT growth is associated with adverse outcomes. SCT growth rate determined by ultrasound is an effective prognostic indicator for adverse outcomes and easily applied to patient management.
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Affiliation(s)
- Alan Coleman
- Division of Pediatric, General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Cincinnati Fetal Center, Cincinnati, OH, USA
| | - Aimen Shaaban
- Division of Pediatric, General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Cincinnati Fetal Center, Cincinnati, OH, USA
| | - Sundeep Keswani
- Division of Pediatric, General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Cincinnati Fetal Center, Cincinnati, OH, USA
| | - Foong-Yen Lim
- Division of Pediatric, General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Cincinnati Fetal Center, Cincinnati, OH, USA.
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Abstract
This review addresses specific questions regarding performance and utility of fetal MR. The specific issues addressed are (1) physician qualifications; (2) MR safety; (3) access to fetal MR; (4) timing of MRI in pregnancy; (5) repeat exams; and (6) when MRI is most effective for prenatal diagnosis. Fetal MRI is a problem-solving tool used for specific indications that are driven by ultrasound or at times by family history. Fetal MR should always be performed with knowledge of the sonographic findings from prior targeted scan. The best evidence for utility of MR is in assessment of CNS anomalies and assessment of the fetus with airway obstruction requiring decisions regarding mode of therapy. The type of information provided by MR can profoundly impact patient counseling and management. We recommend a team approach including specialists in obstetric imaging, fetal MRI, and postnatal care in interpreting MR so that the best information can be given to the pregnant patient.
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Affiliation(s)
- Deborah Levine
- Harvard Medical School, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA.
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Prenatal solid tumor volume index: novel prenatal predictor of adverse outcome in sacrococcygeal teratoma. J Surg Res 2013; 184:330-6. [DOI: 10.1016/j.jss.2013.05.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 04/04/2013] [Accepted: 05/07/2013] [Indexed: 11/19/2022]
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Saleem SN. Fetal MRI: An approach to practice: A review. J Adv Res 2013; 5:507-23. [PMID: 25685519 PMCID: PMC4294280 DOI: 10.1016/j.jare.2013.06.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 06/03/2013] [Accepted: 06/04/2013] [Indexed: 11/25/2022] Open
Abstract
MRI has been increasingly used for detailed visualization of the fetus in utero as well as pregnancy structures. Yet, the familiarity of radiologists and clinicians with fetal MRI is still limited. This article provides a practical approach to fetal MR imaging. Fetal MRI is an interactive scanning of the moving fetus owed to the use of fast sequences. Single-shot fast spin-echo (SSFSE) T2-weighted imaging is a standard sequence. T1-weighted sequences are primarily used to demonstrate fat, calcification and hemorrhage. Balanced steady-state free-precession (SSFP), are beneficial in demonstrating fetal structures as the heart and vessels. Diffusion weighted imaging (DWI), MR spectroscopy (MRS), and diffusion tensor imaging (DTI) have potential applications in fetal imaging. Knowing the developing fetal MR anatomy is essential to detect abnormalities. MR evaluation of the developing fetal brain should include recognition of the multilayered-appearance of the cerebral parenchyma, knowledge of the timing of sulci appearance, myelination and changes in ventricular size. With advanced gestation, fetal organs as lungs and kidneys show significant changes in volume and T2-signal. Through a systematic approach, the normal anatomy of the developing fetus is shown to contrast with a wide spectrum of fetal disorders. The abnormalities displayed are graded in severity from simple common lesions to more complex rare cases. Complete fetal MRI is fulfilled by careful evaluation of the placenta, umbilical cord and amniotic cavity. Accurate interpretation of fetal MRI can provide valuable information that helps prenatal counseling, facilitate management decisions, guide therapy, and support research studies.
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Affiliation(s)
- Sahar N Saleem
- Department of Radiology, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
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Abstract
Building upon over 30 years of experimental and clinical development, fetal surgery can be argued to be a standard of care for selected indications, though application of these techniques remains limited to a small number of highly selected fetuses, and availability to a small number of highly specialized centers. Despite its limited application to date, the field of fetal surgery continues to evolve, spurred both by technological advances allowing earlier and more accurate diagnosis of fetal anomalies as well as improved capability to intervene when appropriate. The efficacy of fetal surgical intervention has now been validated for selected indications by well-designed, randomized controlled trials. In this review, we summarize the evidence or lack thereof supporting the current most common indications for fetal surgical intervention.
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40
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Fetal magnetic resonance imaging and three-dimensional ultrasound in clinical practice: Applications in prenatal diagnosis. Best Pract Res Clin Obstet Gynaecol 2012; 26:593-624. [DOI: 10.1016/j.bpobgyn.2012.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 06/08/2012] [Indexed: 01/09/2023]
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O'Connor SC, Rooks VJ, Smith AB. Magnetic resonance imaging of the fetal central nervous system, head, neck, and chest. Semin Ultrasound CT MR 2012; 33:86-101. [PMID: 22264906 DOI: 10.1053/j.sult.2011.10.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Magnetic resonance imaging (MRI) has become an important tool in the assessment of fetal anomalies. Although ultrasound remains the modality of choice for screening, MRI offers several advantages that permit optimal characterization of anomalies in certain situations. Accurate recognition and characterization of fetal anomalies guides decisions about pregnancy management and coordination of postnatal care. This article will briefly review safety and practical aspects of fetal MRI. We will then provide a concise summary of the most common indications for fetal MRI, and discuss the differential diagnosis and role of MRI in assessment of fetal brain, head, neck, spine, and chest anomalies.
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Affiliation(s)
- Stephen C O'Connor
- Department of Radiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA 01199, USA. Stephen.o'
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42
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Gucciardo L, Uyttebroek A, De Wever I, Renard M, Claus F, Devlieger R, Lewi L, De Catte L, Deprest J. Prenatal assessment and management of sacrococcygeal teratoma. Prenat Diagn 2011; 31:678-88. [DOI: 10.1002/pd.2781] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 04/14/2011] [Accepted: 04/20/2011] [Indexed: 11/08/2022]
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AMINI HASHEM, WIKSTRÖM JOHAN, AHLSTRÖM HÅKAN, AXELSSON OVE. Second trimester fetal magnetic resonance imaging improves diagnosis of non-central nervous system anomalies. Acta Obstet Gynecol Scand 2011; 90:380-9. [DOI: 10.1111/j.1600-0412.2011.01071.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Teratomas are composed of multiple tissues foreign to the organ or site in which they arise. Their origin is postulated by 3 theories one of which is the origin from totipotent primodial germ cells. Anatomically, teratomas are divided into gonadal or extragonadal lesions and histologically they are classified as mature or immature tumors. Teratomas are mainy isolated lesions and may occur anywhere in the body. In the neonatal age group most of these tumors are benign and occur mainly in the sacrococcygeal area followed by the anterior mediastinum. Diagnosis is usually established prenatally and may require intervention in compromised fetuses. Postnatal imaging with ultrasound, CT scan or MRI provides useful information for surgical intervention. Complete surgical excision is the treatment of choice for neonatal teratomas. Alpha feto protein is the tumor marker of choice and is particularly useful for assessing the presence of residual or recurrent disease.
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Affiliation(s)
- Kokila Lakhoo
- Children's Hospital Oxford, John Radcliffe Hospital, University of Oxford, Headley Way, Headington, Oxford OX3 9DU, United Kingdom.
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45
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Castro CA, Ben-Yehudah A, Ozolek JA, Mills PH, Redinger CJ, Mich-Basso JD, McFarland DA, Oliver SL, Ahrens ET, Schatten G. Semiquantitative histopathology and 3D magnetic resonance microscopy as collaborative platforms for tissue identification and comparison within teratomas derived from pedigreed primate embryonic stem cells. Stem Cell Res 2010; 5:201-11. [PMID: 20864427 DOI: 10.1016/j.scr.2010.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 07/28/2010] [Accepted: 07/29/2010] [Indexed: 12/19/2022] Open
Abstract
Teratoma formation in xenografts is a sufficiently stringent pluripotency assay for stem cells. However, little is known about the composition and spatial relationships of tissues within teratomas that may provide clues about development and platforms for studying organ development. Additionally, teratoma formation and analysis lack standards for reporting as assays of pluripotency. Three of 27 total teratomas derived from pedigreed primate embryonic stem cells underwent quantitative three-dimensional high-resolution magnetic resonance microscopy (MRM). Teratomas were subsequently serially sectioned and tissue types identified, semiquantitated, and correlated with MRM images. All teratomas demonstrated tissue derivatives from the three germ layers and approximately 23 different tissue types were identified. Certain tissue groups attempted to form organs more frequently (e.g., trachea/bronchi, small intestine). MRM discriminated some tissues readily (e.g., bone, adipose, cartilage) while other tissue types with like MR intensities could not be distinguished. Semiquantitative histopathological analysis of teratomas demonstrates the ability to delineate multiple tissues as derived from ectoderm, mesoderm, or endoderm and to use this information for comparison to other teratomas. MRM provides rapid quantitative imaging of intact teratomas that complements histology and identifies sites of interest for additional biological studies.
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Affiliation(s)
- Carlos A Castro
- Pittsburgh Development Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Hüsler MR, Danzer E, Johnson MP, Bebbington M, Sutton L, Adzick NS, Wilson RD. Prenatal diagnosis and postnatal outcome of fetal spinal defects without Arnold-Chiari II malformation. Prenat Diagn 2010; 29:1050-7. [PMID: 19688779 DOI: 10.1002/pd.2348] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the prenatal evolution/natural history and postnatal outcome of fetuses diagnosed with a neural tube defect (NTD) lacking the Arnold-Chiari-II malformation (ACM II). MATERIAL AND METHODS This retrospective study reviewed 16 fetuses evaluated with ultrasound (US) and MRI at a single referral center from 1/2000 to 8/2007. Follow-up studies and available postnatal outcomes were reviewed. RESULTS Postpartum diagnosis was terminal myelocystoceles 7/16 (44%); myelomeningoceles (MMCs) 3/16 (19%); lipomyelomeningoceles 2/16(13%); and thoracic myelocystocele 1/16 (6%). Three patients (19%) were lost to follow-up or termination of pregnancy. Two prenatally diagnosed 'closed' NTD were postnatally found to be MMCs. Three of the myelocystoceles had additional omphalocele, bladder extrophy, imperforate anus and spinal defect (OEIS complex). For the total cohort, impaired lower extremity function was seen in 38%, impaired bladder function in 64%, and ventriculoperitoneal shunting in 8%. Four fetuses with a myelocystocele developed hindbrain herniation in the third trimester of pregnancy. The preterm delivery rate was 38%. Five of eight (63%) neonates with postnatally diagnosed myelocystoceles had mothers with a body mass index over 30. CONCLUSION Prenatal differentiation between closed and open NTD is not always possible. Postnatal outcome of isolated myelocystocele and MMC seems to be more favorable than for an NTD with ACM II (shunt requirement). Incontinence is the major childhood morbidity. Maternal obesity may be a risk factor for closed NTDs.
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Abstract
Fetal magnetic resonance imaging (MRI) may add important diagnostic information to prenatal sonography and has the power to confirm or change decisions at critical points in clinical care. Recent studies have shown MRI to be a critical clinical adjunct in the evaluation of the developing central nervous system (CNS), especially at early gestational ages, and MRI has been used in three significant ways: (1) for the quantification of brain growth and structural abnormalities using biometry, (2) for the qualitative evaluation of CNS microstructure, and (3) for the qualitative assessment of dynamic fetal movements in utero.
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48
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Sebire NJ, Jauniaux E. Fetal and placental malignancies: prenatal diagnosis and management. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:235-244. [PMID: 19009536 DOI: 10.1002/uog.6246] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Fetal and placental malignancies are rare complications during pregnancy, but when they occur they may present significant challenges for the perinatology team. Owing to their rarity, there is limited information on many of these entities, with much data derived from individual case reports or small case series. Prenatal diagnosis of these entities is rare and inconsistent, usually in the form of isolated case reports. In the majority of fetal tumors, prenatal features are those of a mass lesion, with or without other non-specific features of fetal compromise such as polyhydramnios, fetal hydrops or intrauterine death, the final diagnosis in most cases being based on postnatal pathological examination.Expectant management is almost always indicated antenatally, with serial ultrasound examinations performed to detect rapid enlargement, metastasis or secondary fetal complications, such as non-immune hydrops, which may require intervention. Delivery should be planned in a specialist center in conjunction with pediatric surgeons and oncologists to allow appropriate neonatal management. Placental malignancy is most commonly in the form of gestatational trophoblastic disease, which requires assessment and management in specialist centers.
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Affiliation(s)
- N J Sebire
- Department of Paediatric Pathology, Great Ormond Street Hospital, London, UK
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49
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Huisman TAGM, Solopova A. MR fetography using heavily T2-weighted sequences: comparison of thin- and thick-slab acquisitions. Eur J Radiol 2008; 71:557-63. [PMID: 18619753 DOI: 10.1016/j.ejrad.2008.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Revised: 05/27/2008] [Accepted: 06/03/2008] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the use of MR-fetography sequences in identifying the major fetal structures and to compare thick- and thin-slab acquisitions for their diagnostic value. MATERIALS AND METHODS Twenty-one consecutive, pregnant women with suspected fetal pathology underwent fetal magnetic resonance imaging (MRI) using a 1.5 T MRI unit. Heavily T2-weighted, single-shot fast spin-echo (SSFSE) sequences with a long echo train (MR-fetography) were acquired in a thick- and thin-slab modus. Thick- and thin-slab acquisitions were reviewed by two experienced radiologists with regard to the overall image quality and landmark anatomical structures (spinal canal, spinal cord, posterior fossa, cerebellum, brainstem, basal cisterns, stomach, urinary bladder and umbilical cord according to a three-scale grading system (good, moderate and poor). Visibility scores were calculated and compared between both sequences. RESULTS Overall image quality was graded good in 76.2%, moderate in 19.0% and poor in 4.8% for thick-slab images and good in 81%, moderate in 14.3% and poor in 4.8% for thin-slab images. The visibility scores of the thick/thin-slab images for evaluation of the main fetal structures were as follows: for the spinal canal 2.8+/-0.4/2.9+/-0.54 (p>0.05), spinal cord 2.4+/-0.75/2.7+/-0.66 (p>0.05), posterior fossa components (cerebellum, brainstem and basal cisterns) 2.4+/-0.68/2.8+/-0.54; 2.4+/-0.67/2.7+/-0.66; 2.5+/-0.51/2.7+/-0.56 (p<0.05), stomach 2.8+/-0.44/2.9+/-0.48 (p>0.05), urinary bladder 2.8+/-0.51/2.8+/-0.54 (p>0.05) and umbilical cord 2.9+/-0.30/2.6+/-0.60 (p<0.05). CONCLUSION Heavily T2-weighted MR-fetography renders a quick overview of fetal contours, fetal position, amount of amniotic fluid and integrity and presence of several major fluid containing structures. Thick- and thin-slab acquisitions render complementary information. Thick-slab images display the entire fetus in one projection while thin-slab images provide more detailed anatomical information. The short imaging time usually allows measuring both thick- and thin-slab images. MR-fetography is as a helpful addition to conventional fetal MRI. MR-fetography should not be viewed as a single, stand alone sequence but as a supporting fast MR sequence in a well-designed multisequence fetal MRI protocol. Future studies evaluating larger patient groups are mandatory.
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Affiliation(s)
- Thierry A G M Huisman
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Switzerland.
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50
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Cystic sacrococcygeal teratoma. Ultrasound Q 2008; 24:97-100. [PMID: 18528246 DOI: 10.1097/ruq.0b013e31817b6247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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