SUMMARY During the last decade there has been increasing interest in MRI for the evaluation of ultrasound‐detected fetal abnormalities. Motion artefacts previously precluded detailed imaging, but this is now possible using single‐shot rapid acquisition sequences. These ultrafast techniques with subsecond images capture ‘snap‐shot’ views of the fetus. By virtue of the infinitely long relaxation time (TR) these images are heavily T2‐weighted so that fluid around and within the fetus delineates the anatomy. Currently, fetal MRI has shown to be most beneficial in the investigation of cerebral abnormalities suspected from sonography, and in the detection of subtle associated anomalies. It clearly has a role in the evaluation of complex somatic abnormalities, and is helpful in the evaluation of fetuses prior to surgery. We present a pictorial review of our experience with single‐shot fast spin‐echo (SSFSE) imaging, demonstrating normal anatomy of the fetal brain and body. In addition we present cerebral and somatic abnormalities to illustrate cases where we have found fetal MRI to be a useful adjunct to sonography.
Departments of *Obstetrics and Gynecology and †Radiology, University of Utah Hospitals and Clinics, Salt Lake City, Utah; the ‡Department of Maternal Fetal Medicine, St. Mark's Hospital, Salt Lake City, Utah; and the §Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, Utah Correspondence: Michael A. Belfort, MD, PhD, St. Mark's Hospital, 1140 E 3900 S Ste 390, Salt Lake City, UT 84124. E-mail: [email protected]
There are approximately 179 million cases of acute diarrhea illness in the United States each year. Worldwide, gastroenteritis accounts for two to three million deaths per year, most frequently at the extremes of age in developing countries. Diarrhea is defined as the passage of three or more unformed stools per day or the passage of more than 250 g of unformed stool per day. Acute diarrhea lasts less than 14 days. Diarrhea that persists for more than 3 weeks is considered chronic. A general approach to these patients involves defining the diarrhea to include volume and blood or mucus content, assessing for risk factors, assessing for invasive disease, determining the level of dehydration, and performing testing when indicated [1, 2].
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To review prenatal diagnosis of a rare chromosome abnormality based on sonographic features and confirmed by molecular analysis. Prospective identification of a case seen in an academic referral center. 25 y.o. G2P0010 referred at 30 wk gestation for a suspected cleft lip on ultrasound. Comprehensive ultrasound using 2D and 3D imaging revealed a singleton female fetus with a bilateral cleft lip and palate. In addition, a prominent glabella with a broad and flat nasal root, hypertelorism and anti-mongoloid slant of the palpebral fissures were seen. Severe IUGR and hypoplastic kidneys were also noted. The heart was normal. The facial features were suggestive of a “Greek warrior helmet” appearance, a characteristic of Wolf-Hirschhorn syndrome (WHS) or 4p-. Amniocentesis confirmed a deletion of 4p and FISH confirmed the deletion of the WHS critical region. WHS is a rare contiguous gene deletion syndrome characterized by a hemizygous deletion of 4p16.3. It occurs in 1/20,000–50,000 births and is characterized by IUGR, multiple craniofacial and other midline anomalies. Survivors usually exhibit mental retardation and seizures. The diagnosis may be suspected prenatally in a fetus with severe IUGR, but has been reported infrequently. This case illustrates the utility of 3D imaging in the recognition of characteristic facial morphology, thus allowing targeted diagnostic testing. Supporting information can be found in the online version of this abstract. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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